RN Clinical Reimbursement Specialist

INTEGRIS Health; Oklahoma; On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Front-loaded PTO

Medical benefits

Education assistance

24/7 mental health support

Job summary

INTEGRIS Health in Oklahoma City seeks an RN Clinical Reimbursement Specialist to optimize payer reimbursements and manage clinical denials. You will lead appeals, support the chargemaster, and collaborate with case management and departments to maximize revenue.

The role requires an active nursing license in Oklahoma and experience with government payors and managed care. Join a mission-driven health system.

Qualifications

• Licensed nurse with strong knowledge of government payor rules.
• Experience with managed care contracts, reimbursement and financial analysis.
• Ability to communicate effectively in English.

Responsibilities

• Identify and prepare clinical appeals for government and payors.
• Maintain chargemaster descriptions and related audit functions.
• Oversee clinical denial management and analyze denial trends.
• Develop preventive strategies with physicians and leaders.
• Prepare monthly denial reports for senior leadership.
• Support case management and other departments on payor issues.
• Educate staff on payer rules, documentation and compliance.

Skills

English communication

Reimbursement knowledge

Case management experience

Education

LPN/RN license in Oklahoma or eNLC multi-state license

8 years experience with healthcare facilities, health insurance or managed care

10 years demonstrated experience with healthcare facilities, health insurance or managed care

Job description

Job Description

Join our team as a RN Clinical Reimbursement Specialist at INTEGRIS Health in Oklahoma City, OK.

Job Description

Join our team as a RN Clinical Reimbursement Specialist at INTEGRIS Health 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 your first step toward growing your career by joining us.

Responsibilities

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.

The RN Clinical Reimbursement Specialist responsibilities include, but are not limited to, the following:

• 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.

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.

About Us

INTEGRIS Health mission:

Partnering with people to live healthier lives.

To our patients, that means we will partner to provide unprecedented access to quality and compassionate health care. To you, it means some of the state's best career and development opportunities. With INTEGRIS Health, you will have a genuine chance to make a difference in your life and your career.

INTEGRIS Health is the state's largest Oklahoma-owned health system with hospitals, rehabilitation centers, physician clinics, mental health facilities and home health agencies throughout much of the state.