RN Clinical Reimbursement Specialist

INTEGRIS Health; Oklahoma; On-site; USD 45,000 - 65,000; Full time

Job summary

INTEGRIS Health in Oklahoma City is seeking a day shift, full-time Patient Accounting Specialist to support the revenue cycle and clinical denial management across the system.

The role focuses on training staff, overseeing denial processes, and ensuring accurate reimbursement while aligning with payer rules and government regulations.

Qualifications

• Current LPN or RN license in Oklahoma or a multistate license via eNLC.
• 8 years of experience with healthcare facilities, health insurance or managed care.
• 6 years of direct managed care or case management experience.
• Knowledge of government rules, managed care contracts, provider relations, pre-certification, reimbursement, financial analysis and patient accounting.
• Must communicate effectively in English (verbal/written).

Responsibilities

• Assist the Director of Revenue Recovery in training INTEGRIS recovery staff on clinical and non-clinical payment issues.
• Oversee and manage the INTEGRIS System clinical denial management process.
• Identify denial and payment trends and help develop plans to maximize reimbursement.
• Participate in Utilization Management Committee to report denial issues and develop preventive strategies with physicians.
• Analyze, prepare and distribute monthly denial reports to VPs, Directors and Managers.
• Respond to clinical denials from government contracted vendors for Medicare and Medicaid.
• Support Case Management and other departments with payor and patient denial inquiries.
• Assist the Chargemaster Consultant in chargemaster development, maintenance and audit functions.
• Analyze denial trends and drive cross-departmental process improvements.
• Identify charging, coding or documentation issues and notify leadership.
• Educate on government and managed care payer rules and requirements.

Skills

LPN/RN license

Healthcare/managed care experience

English communication

Knowledge of payer rules

Job description

Join our team as a day shift, fulltime, Patient Accounting Specialist, at INTEGRIS Health Corporate Office, in Oklahoma City, OK.

Join our team as a day shift, fulltime, Patient Accounting Specialist, at INTEGRIS Health Corporate Office, in Oklahoma City, OK.

Get to Know Your Team

• INTEGRIS Health, Oklahoma’s largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives.
• Benefits of being an INTEGRIS Health caregiver include front-loaded PTO, medical benefits through the extensive INTEGRIS Health network, financial assistance for continued education, 24/7 mental health support and more.
• Take the first step toward growing your career by joining us.

The RN Clinical Reimbursement Specialist is responsible for identifying and preparing clinical appeals for government, managed care organizations, and various other payors. Provides assistance and guidance in the maintenance of the charge description master for the INTEGRIS Health system. INTEGRIS is an Equal Opportunity/Affirmative Action Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

Responsibilities

• 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 insure 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 in regards to 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. Minimal. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

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.and 8 years experience working with healthcare facilities, health insurance or managed care companies, and 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)

INTEGRIS Health is an Equal Opportunity Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.