Internal Review Coordinator
Arkansas Foundation for Medical Care - Fort Smith, AR

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Responsible for analyzing patient records to determine legitimacy and necessity of medical services in compliance with government reimbursement policies. Review may be prior authorization, concurrent with service or post service. Review findings may be referred to a physician advisor for final determination.

ESSENTIAL JOB FUNCTIONS :

1. Review each selected record accurately and according to AFMC, state and federal policies and procedures.

2. Write effective and accurate review summaries and submit within appropriate time frame.

3. Refer all cases requiring additional review to the appropriate reviewer on a daily basis.

4. Maintain files for recording and reporting in accordance with established procedures.

5. Perform site surveys as required or directed.

6. Prepare monthly reports and/or statistics as directed.

7. Communicate effectively with internal and external clients.

8. Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.

9. Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.

10. Additional duties as assigned.

Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices) :

Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to travel as needed. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.

EDUCATION :

Required : Diploma or Associate’s degree in nursing, licensed as a Registered Nurse in the state of Arkansas, Must successfully complete ICD-9-CM and CPT coding workbook within 90 days of employment

Desirable : Bachelor’s degree in nursing

EXPERIENCE :

Required : Three (3) years clinical nursing experience

Desirable : Quality Assurance / Utilization Review and/or coding experience, QIO experience

KNOWLEDGE, SKILLS, AND ABILITIES :

Intermediate level computer skills (Excel, Word, Access, PowerPoint and Outlook)

Type 50 wpm

Exceptional skills in business English and spelling are required

Ability to maintain confidentiality

Strong oral and written communication skills

Creativity

Customer service

Ability to meet deadlines

Attention to detail

Flexibility

Knowledge of ICD 9 Coding

Knowledge of HIT/EHR

Medical terminology

Ability to work collaboratively and independently to achieve stated goals

Initiative

Ability to relate professionally and positively with staff, business partners, customers, constituents, recipients and the public

Ability to multitask

Ability to prioritize

Strong organizational skills

Problem solving skills

Professionalism

Project management skills

Ability to read, interpret and apply laws, rules and regulations

Knowledge of quality improvement processes and techniques

Time management skills

Arkansas Foundation for Medical Care - 18 months ago - save job
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