RN Clinical Reimbursement Specialist

About Us

INTEGRIS Health is Oklahoma's largest not-for-profit health system, with hospitals, rehabilitation centers, physician clinics, mental health facilities, and home health agencies throughout much of the state. Our mission is partnering with people to live healthier lives. To our patients, that means providing unprecedented access to quality and compassionate health care. To you, it means career and development opportunities with a genuine chance to make a difference.

Responsibilities

• Identifies and prepares clinical appeals for government, managed care organizations, and various other payors.
• Assists the Director of Revenue Recovery in the training and development of all INTEGRIS recovery staff related to clinical and non-clinical payment issues.
• Oversees and manages the INTEGRIS System clinical denial management process.
• Identifies inaccurate and/or problematic denial and payment trends and assists with the development of a plan to ensure facilities receive maximum reimbursement.
• Participates in Utilization Management Committee for all INTEGRIS facilities to report denial issues and develop preventive strategies in collaboration with the physicians.
• Analyzes, prepares, and distributes monthly denial reports to Vice Presidents, Directors, and Managers of specified hospital departments.
• Responds to utilization management clinical denials issued by government contracted vendors for the Medicare and Medicaid programs.
• Supports Case Management and other hospital departments with clinical expertise regarding both payor and patient clinical denial inquiries.
• Assists the Chargemaster Consultant in the development, implementation, maintenance, and audit functions related to the chargemaster description master.
• Analyzes denial trends for documentation or charging issue opportunities and facilitates cross-departmental collaboration to improve processes and develop best practices.
• Identifies charging, coding, or clinical documentation issues and works with ancillary departments to resolve issues and notify appropriate leadership.
• Educates and maintains effective and practical knowledge of government and managed care payer rules, regulations, and requirements.
• Reports to assigned Corporate Manager.

This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information.

Qualifications

• Current licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state.
• 8 years' experience working with healthcare facilities, health insurance, or managed care companies.
• 10 years demonstrated experience working with healthcare facilities, health insurance, or managed care companies.
• 6 years of direct managed care or case management experience.
• Knowledge and proficiencies with government rules and regulations, managed care contracts, provider relations, pre-certification, reimbursement, financial analysis, and patient accounting.
• Knowledge of legal documents, collection agency procedures, and contract documents.
• Must be able to communicate effectively in English (Verbal/Written).

Benefits

• Front-loaded PTO.
• Medical benefits through the extensive INTEGRIS Health network.
• Financial assistance for continued education.
• 24/7 mental health support.