Use clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process
Job Summary
Use clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process.
Provide support to the CBO Medicare billing area in the form of correcting billing errors before the bill is sent to the payer.
Goals and objectives include continuing to foster effective working relationships with Nurse Managers, clinical staff, and CBO departments providing education and clinical support as appropriate.
Matching Summary
Use clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process.
Skills & Requirements
Must-have
clinical knowledge
ambulatory medical necessity denials
appeals process
scientific evidence
clinical education to payers
identifying denial trends
Nice-to-have
support clinicians
mitigate revenue risk
correct billing errors
review clinical data
impact on revenue
pre-certification support
Key Requirements
Associate Degree in Nursing preferred
Minimum of 3 years oncology experience preferred
Minimum of 3 years experience in oncology
Experience with Windows, Excel, Access
Experience in physician practice or utilization review a plus
Knowledge of Medicare and commercial insurance reimbursement preferred
Strong knowledge of ICD-9-CM, HCPCs, and CPT coding preferred
Excellent verbal and written skills required
Proficient in computer based research and medical record documentation