Registered Nurses - Recovery Audit & Appeals
Day shifts as needed
Ministry Saint Joseph's Hospital is currently searching for a
Recovery Audit and Appeals Registered Nurse Analyst
to be based in Marshfield WI.
The Recovery Audit and Appeals RN is part of Recovery Audit Contractor (RAC) Services and works collaboratively with Ministry facilities and multiple system-wide departments including but not limited to patient financial services, hospital coding, clinical documentation specialists, compliance, integrity and administration both at the facility and corporate level. The Registered Nurse Analyst is responsible for review of medical records to ascertain appeal information and for the development of appeals correspondence. Analyzes clinical denials based on severity of illness and intensity of service using InterQual criteria, coding guidelines and CMS guidelines. Analyzes and reports data of audits at the facility and system-wide level. Provides education to Ministry staff and physicians to reduce future audit exposure.
Essential Duties & Responsibilities include:
Demonstrates aptitude for detail
Ability to work independently with minimal direct supervision and make independent decisions
Ability to manage multiple priorities and deadlines
Demonstrates critical thinking skills in relation to chart reviews and appeals management
Prepare and present high level professional presentations including preparation of presentations for national conferences
Willingness to accept new responsibilities in response to changing system and regulatory requirements
Participates in multisystem and multidisciplinary collaboration
Bachelors degree in nursing is required
Current Registered Nurse licensure in State of Wisconsin is required
3-5 years experience as professional nurse required. We will not accept new grads into this position.
1-2 years utilization management/case management experience preferred
InterQual experience preferred
Normal Weekly Hours
Staff Registered Nurses
WI-Marshfield-Saint Joseph's Hospital
Saint Joseph's Hospital
Ministry Health Care - 2 years ago