Registered Nurse Clinical Denials Supervisor Temporary
for section headings; they gave examples but not exclusive. Probably we can use "About Us" as a heading. However they said use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). That suggests those are typical headings; we can also use other headings if appropriate. Safer to include "About Us" as a heading.
We must not repeat the job title as a heading. The job title is "Clinical Denial Supervisor". Not to be used as heading.
We must not put Job ID/requisition numbers as headings; none present.
We must remove boilerplate: EEO statements, ADA, Ethics, etc. Remove duplicated lines. Also remove application instructions (none). Remove cookie/navigation/legal etc.
We need to preserve all substantive information: job summary, duties, requirements, about us, maybe certification details.
We need to use - for any list of duties/requirements/benefits. The duties are a long paragraph with many sentences; we could break into list items for each duty. The posting includes many duty sentences separated by periods. We should convert to list items. Similarly requirements: list items.
We need to use
for prose. So sections with prose can be
. For lists, use
- .
We must not invent or summarize away detail. Must preserve all substantive information. So we need to include all details from duties and responsibilities, requirements, about us.
Let's extract content.
Job Summary paragraph: "Under the general supervision of the Care Management Leadership, the Clinical Denial Supervisor performs advanced level work related to clinical denial management. The individual is responsible for managing medical denials for hospital care by conducting a comprehensive review of clinical documentation. The Clinical Denial Supervisor will write compelling arguments based on the clinical documentation and the medical policies of the payer and submit the appeal in a timely manner. The Clinical Denial Supervisor will also handle audit-related / compliance responsibilities and other administrative duties as required. The position identifies and works to resolve problems to ensure accurate and complete billing, and works with the care management leadership and physician advisors to educate staff on follow-up and documentation practices. The position reviews third party payer reimbursement denials for hospital services based on the following: documentation, medical necessity, and related issues. Using data from these reviews, the Clinical Denial Specialist will work with care management staff to identify and rectify documentation errors. Additionally, this position will actively manage, maintain and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management. This position anticipates and responds to a wide variety of issues/concerns. The position works independently to plan, schedule and organize activities that directly impacts hospital and physician reimbursement. This role is key to securing reimbursement and minimizing organizational write offs. This position represents Care New England, the Care Management team at Women and Infants Hospital, and the Revenue Cycle team by adhering and upholding the Mission, Vision, and Values, and Service Performance Standards in providing the highest quality service. They will support their co-workers, engage in positive interactions, and provide helpful assistance in anticipating and responding to the needs of our customers."
We need to keep all that. Could be a
under About the role.
Duties & Responsibilities: list of bullet-like sentences. Let's extract each duty sentence.
"Research clinical denials related to referral, medical necessity, case management, non-covered services, resulting in denials and delays in payment."
"Initiate appeals with insurers appropriately."
"Other types of denials may be requested for the specialist to research, review and appeal through the care management leadership."
"Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as CNE policies and procedures"
"Initiate Peer to Peer reviews as appropriate and communicate thoroughly and accurately with payers and Peer Review organizations to resolve denials"
"Monitor and follows up on appeals throughout entire process"
"Maintains accurate, clear, timely documentation related to denied cases"
"Develops, implements, and evaluates processes to ensure accurate and timely collection of information."
"Serve as a resource for hospital case management departments regarding concurrent denials"
"Assist the Care Management department on implementing a strong process that will help prevent claims denials and lodge successful requests for appeals"
"Works with and educates staff, physicians, and payers on reimbursement issues, clinical protocols/criteria, insurance plan changes, regulations and process improvements."
"Coordinate appropriate status determinations using InterQual and Medicare guidelines"
"Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution"
"Tabulates the financial gains of the position and opportunities for improvement"
"Review payer communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate"
"Submits retro-authorizations in accordance with payer requirements in response to authorization denials"
"Assist with clinical support for complex, specialized billing and follow-up workflows including but not limited to:"
Then sublist: "RAC correspondence and appeal processing, as well as other audit reviews"
"Advanced billing procedures requiring extensive communication with other departments"
"Consecutive account processing and Medicare A/B split claims processing"
"Supports director in other related responsibilities as requested"
"Responds to patient and family inquiries regarding denials"
"Serves as a resource, maintains expertise and continues self-education by attending applicable conferences, workshops and interdisciplinary meetings."
"Utilizes local, regional and national forums to continuously enhance expertise and knowledge base."
"Participates in applicable professional organizations and committees."
We need to keep all. Could flatten sub-items as separate list items.
Requirements: list.
"Bachelor’s degree in nursing preferred and a minimum of 2 years job-related experience or equivalent is required."
"RI State Nursing Licensure is also required."
"Experience must include graduation from an accredited nursing program."
"Two years recent experience in hospital case management with demonstrated competency in InterQual and/or MCG and Medicare rules and regulations."
"Knowledge of and comfort with EMR functionality required."
"Previous management of clinical appeals preferred."
"Certification in Care Management, CCM or ACM required."
"Upon hire will obtain Certification in Care Management within two years of hire if not already in place."
About Us paragraph: "Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve."
We should not include EEO statements etc.
Now produce HTML.
Structure:
About the role
Job summary paragraph.
Responsibilities
- ...
...
Requirements
- ...
...
About Us
About us paragraph.
We should not add Benefits, Pay, Schedule.
Check for any duplicate lines: ensure we didn't repeat.
Make sure to preserve all details exactly as in posting, but we can rephrase? The instruction: Preserve ALL substantive information; do NOT invent or summarize away detail. So we should keep the wording as close as possible. Slight changes for list formatting okay but must not lose info.
Let's copy duties exactly as sentences.
I'll produce list items with the sentences exactly as they appear (maybe minor punctuation). Ensure no missing.
Let's list them:
1. Research clinical denials related to referral, medical necessity, case management, non-covered services, resulting in denials and delays in payment.
2. Initiate appeals with insurers appropriately.
3. Other types of denials may be requested for the specialist to research, review and appeal through the care management leadership.
4. Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as CNE policies and procedures
5. Initiate Peer to Peer reviews as appropriate and communicate thoroughly and accurately with payers and Peer Review organizations to resolve denials
6. Monitor and follows up on appeals throughout entire process
7. Maintains accurate, clear, timely documentation related to denied cases
8. Develops, implements, and evaluates processes to ensure accurate and timely collection of information.
9. Serve as a resource for hospital case management departments regarding concurrent denials
10. Assist the Care Management department on implementing a strong process that will help prevent claims denials and lodge successful requests for appeals
11. Works with and educates staff, physicians, and payers on reimbursement issues, clinical protocols/criteria, insurance plan changes, regulations and process improvements.
12. Coordinate appropriate status determinations using InterQual and Medicare guidelines
13. Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution
14. Tabulates the financial gains of the position and opportunities for improvement
15. Review payer communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate
16. Submits retro-authorizations in accordance with payer requirements in response to authorization denials
17. Assist with clinical support for complex, specialized billing and follow-up workflows including but not limited to:
- RAC correspondence and appeal processing, as well as other audit reviews
- Advanced billing procedures requiring extensive communication with other departments
- Consecutive account processing and Medicare A/B split claims processing
18. Supports director in other related responsibilities as requested
19. Responds to patient and family inquiries regarding denials
20. Serves as a resource, maintains expertise and continues self-education by attending applicable conferences, workshops and interdisciplinary meetings.
21. Utilizes local, regional and national forums to continuously enhance expertise and knowledge base.
22. Participates in applicable professional organizations and committees.
We need to decide how to handle sublist. Could keep as separate list items without nesting. Simpler: just list each as separate item, including the sub-bullets as separate items.
Thus items 17a, 17b, 17c.
Let's produce.
Requirements list:
1. Bachelor’s degree in nursing preferred and a minimum of 2 years job-related experience or equivalent is required.
2. RI State Nursing Licensure is also required.
3. Experience must include graduation from an accredited nursing program.
4. Two years recent experience in hospital case management with demonstrated competency in InterQual and/or MCG and Medicare rules and regulations.
5. Knowledge of and comfort with EMR functionality required.
6. Previous management of clinical appeals preferred.
7. Certification in Care Management, CCM or ACM required.
8. Upon hire will
- for any list of duties/requirements/benefits. The duties are a long paragraph with many sentences; we could break into list items for each duty. The posting includes many duty sentences separated by periods. We should convert to list items. Similarly requirements: list items.
We need to use
for prose. So sections with prose can be
. For lists, use
- .
We must not invent or summarize away detail. Must preserve all substantive information. So we need to include all details from duties and responsibilities, requirements, about us.
Let's extract content.
Job Summary paragraph: "Under the general supervision of the Care Management Leadership, the Clinical Denial Supervisor performs advanced level work related to clinical denial management. The individual is responsible for managing medical denials for hospital care by conducting a comprehensive review of clinical documentation. The Clinical Denial Supervisor will write compelling arguments based on the clinical documentation and the medical policies of the payer and submit the appeal in a timely manner. The Clinical Denial Supervisor will also handle audit-related / compliance responsibilities and other administrative duties as required. The position identifies and works to resolve problems to ensure accurate and complete billing, and works with the care management leadership and physician advisors to educate staff on follow-up and documentation practices. The position reviews third party payer reimbursement denials for hospital services based on the following: documentation, medical necessity, and related issues. Using data from these reviews, the Clinical Denial Specialist will work with care management staff to identify and rectify documentation errors. Additionally, this position will actively manage, maintain and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management. This position anticipates and responds to a wide variety of issues/concerns. The position works independently to plan, schedule and organize activities that directly impacts hospital and physician reimbursement. This role is key to securing reimbursement and minimizing organizational write offs. This position represents Care New England, the Care Management team at Women and Infants Hospital, and the Revenue Cycle team by adhering and upholding the Mission, Vision, and Values, and Service Performance Standards in providing the highest quality service. They will support their co-workers, engage in positive interactions, and provide helpful assistance in anticipating and responding to the needs of our customers."
We need to keep all that. Could be a
under About the role. Duties & Responsibilities: list of bullet-like sentences. Let's extract each duty sentence. "Research clinical denials related to referral, medical necessity, case management, non-covered services, resulting in denials and delays in payment." "Initiate appeals with insurers appropriately." "Other types of denials may be requested for the specialist to research, review and appeal through the care management leadership." "Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as CNE policies and procedures" "Initiate Peer to Peer reviews as appropriate and communicate thoroughly and accurately with payers and Peer Review organizations to resolve denials" "Monitor and follows up on appeals throughout entire process" "Maintains accurate, clear, timely documentation related to denied cases" "Develops, implements, and evaluates processes to ensure accurate and timely collection of information." "Serve as a resource for hospital case management departments regarding concurrent denials" "Assist the Care Management department on implementing a strong process that will help prevent claims denials and lodge successful requests for appeals" "Works with and educates staff, physicians, and payers on reimbursement issues, clinical protocols/criteria, insurance plan changes, regulations and process improvements." "Coordinate appropriate status determinations using InterQual and Medicare guidelines" "Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution" "Tabulates the financial gains of the position and opportunities for improvement" "Review payer communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate" "Submits retro-authorizations in accordance with payer requirements in response to authorization denials" "Assist with clinical support for complex, specialized billing and follow-up workflows including but not limited to:" Then sublist: "RAC correspondence and appeal processing, as well as other audit reviews" "Advanced billing procedures requiring extensive communication with other departments" "Consecutive account processing and Medicare A/B split claims processing" "Supports director in other related responsibilities as requested" "Responds to patient and family inquiries regarding denials" "Serves as a resource, maintains expertise and continues self-education by attending applicable conferences, workshops and interdisciplinary meetings." "Utilizes local, regional and national forums to continuously enhance expertise and knowledge base." "Participates in applicable professional organizations and committees." We need to keep all. Could flatten sub-items as separate list items. Requirements: list. "Bachelor’s degree in nursing preferred and a minimum of 2 years job-related experience or equivalent is required." "RI State Nursing Licensure is also required." "Experience must include graduation from an accredited nursing program." "Two years recent experience in hospital case management with demonstrated competency in InterQual and/or MCG and Medicare rules and regulations." "Knowledge of and comfort with EMR functionality required." "Previous management of clinical appeals preferred." "Certification in Care Management, CCM or ACM required." "Upon hire will obtain Certification in Care Management within two years of hire if not already in place." About Us paragraph: "Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve." We should not include EEO statements etc. Now produce HTML. Structure:
About the role
Job summary paragraph.
Responsibilities
- ... ...
Requirements
- ... ...
About Us
About us paragraph.
We should not add Benefits, Pay, Schedule. Check for any duplicate lines: ensure we didn't repeat. Make sure to preserve all details exactly as in posting, but we can rephrase? The instruction: Preserve ALL substantive information; do NOT invent or summarize away detail. So we should keep the wording as close as possible. Slight changes for list formatting okay but must not lose info. Let's copy duties exactly as sentences. I'll produce list items with the sentences exactly as they appear (maybe minor punctuation). Ensure no missing. Let's list them: 1. Research clinical denials related to referral, medical necessity, case management, non-covered services, resulting in denials and delays in payment. 2. Initiate appeals with insurers appropriately. 3. Other types of denials may be requested for the specialist to research, review and appeal through the care management leadership. 4. Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as CNE policies and procedures 5. Initiate Peer to Peer reviews as appropriate and communicate thoroughly and accurately with payers and Peer Review organizations to resolve denials 6. Monitor and follows up on appeals throughout entire process 7. Maintains accurate, clear, timely documentation related to denied cases 8. Develops, implements, and evaluates processes to ensure accurate and timely collection of information. 9. Serve as a resource for hospital case management departments regarding concurrent denials 10. Assist the Care Management department on implementing a strong process that will help prevent claims denials and lodge successful requests for appeals 11. Works with and educates staff, physicians, and payers on reimbursement issues, clinical protocols/criteria, insurance plan changes, regulations and process improvements. 12. Coordinate appropriate status determinations using InterQual and Medicare guidelines 13. Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution 14. Tabulates the financial gains of the position and opportunities for improvement 15. Review payer communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate 16. Submits retro-authorizations in accordance with payer requirements in response to authorization denials 17. Assist with clinical support for complex, specialized billing and follow-up workflows including but not limited to: - RAC correspondence and appeal processing, as well as other audit reviews - Advanced billing procedures requiring extensive communication with other departments - Consecutive account processing and Medicare A/B split claims processing 18. Supports director in other related responsibilities as requested 19. Responds to patient and family inquiries regarding denials 20. Serves as a resource, maintains expertise and continues self-education by attending applicable conferences, workshops and interdisciplinary meetings. 21. Utilizes local, regional and national forums to continuously enhance expertise and knowledge base. 22. Participates in applicable professional organizations and committees. We need to decide how to handle sublist. Could keep as separate list items without nesting. Simpler: just list each as separate item, including the sub-bullets as separate items. Thus items 17a, 17b, 17c. Let's produce. Requirements list: 1. Bachelor’s degree in nursing preferred and a minimum of 2 years job-related experience or equivalent is required. 2. RI State Nursing Licensure is also required. 3. Experience must include graduation from an accredited nursing program. 4. Two years recent experience in hospital case management with demonstrated competency in InterQual and/or MCG and Medicare rules and regulations. 5. Knowledge of and comfort with EMR functionality required. 6. Previous management of clinical appeals preferred. 7. Certification in Care Management, CCM or ACM required. 8. Upon hire will
- .
We must not invent or summarize away detail. Must preserve all substantive information. So we need to include all details from duties and responsibilities, requirements, about us.
Let's extract content.
Job Summary paragraph: "Under the general supervision of the Care Management Leadership, the Clinical Denial Supervisor performs advanced level work related to clinical denial management. The individual is responsible for managing medical denials for hospital care by conducting a comprehensive review of clinical documentation. The Clinical Denial Supervisor will write compelling arguments based on the clinical documentation and the medical policies of the payer and submit the appeal in a timely manner. The Clinical Denial Supervisor will also handle audit-related / compliance responsibilities and other administrative duties as required. The position identifies and works to resolve problems to ensure accurate and complete billing, and works with the care management leadership and physician advisors to educate staff on follow-up and documentation practices. The position reviews third party payer reimbursement denials for hospital services based on the following: documentation, medical necessity, and related issues. Using data from these reviews, the Clinical Denial Specialist will work with care management staff to identify and rectify documentation errors. Additionally, this position will actively manage, maintain and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management. This position anticipates and responds to a wide variety of issues/concerns. The position works independently to plan, schedule and organize activities that directly impacts hospital and physician reimbursement. This role is key to securing reimbursement and minimizing organizational write offs. This position represents Care New England, the Care Management team at Women and Infants Hospital, and the Revenue Cycle team by adhering and upholding the Mission, Vision, and Values, and Service Performance Standards in providing the highest quality service. They will support their co-workers, engage in positive interactions, and provide helpful assistance in anticipating and responding to the needs of our customers."
We need to keep all that. Could be a