Mercyhealth Wisconsin and Illinois

Operations

• Utilizes the nursing process and collaborates with interdisciplinary team members in caring for patients.
• Administers prescribed medications and treatments in accordance with approved nursing techniques, policies and procedures, standards of care, and State laws practice act.
• Documents according to standards of care.
• Performs assessments, planning, intervention, and evaluation of care.
• Develops, initiates, and executes a patient plan of care according to the individualized needs of the patient, as prescribed by Physician and or clinic policy including patient and family instruction.
• Participates in department or unit performance improvement activities, may include shared governance.
• Utilizes clinical expertise and guidance to other units’ departments in support of the patient’s longitudinal plan of care.
• Utilizes critical thinking regarding patient safety and patient experience and appropriately escalates to the appropriate chain of command.
• Participates in the professional nursing continuum process, unit practice activities and decisions and peer review process.

Registered Nurse – PACU / OPS

Analyst

• Interpret and understand coverage and benefit limitations by having a comprehensive understanding of benefits and state requirements for multiple markets.
• Identify trends and suggest and develop efficiencies in the revenue cycle through review and trending of payer contracts and reimbursement trends.
• Research and trends denials from payors.
• Reads through healthcare contracts and contract language and ensures proper contract workflows.
• Researches remittances and Explanation of Benefits (EOBs) for complete accurate payments or denials.
• Work with payers to understand specific reasons for variances and/or denials and measures to prevent future denials.
• Research payer policies and requirements and utilize knowledge to determine whether an appeal is required and to get claims overturned.
• Develop sound and well-supported appeal arguments, where an appeal is warranted.
• Submits corrected claims and appeals.
• Coordinates appeals with clinical or coding areas within the revenue cycle.
• Requests appropriate adjustments, when required.
• Provide training and guidance to team members on market specific issues by providing feedback to management on claims and provider issues, and updating client business rules.
• Partner with Reimbursements team to assist in completing all other tasks as necessary to ensure accurate and timely internal turnaround times.

Revenue Cycle Reimbursement Analyst

• Performs moderate to advanced application maintenance as needed in support of requested changes.
• Updates and maintains required documentation and issues lists.
• Able to provide moderate to advanced levels of design and support.
• Consult with the vendors when needed.
• Conducts continual assessment of operational/technical needs and workflow analysis in order to recommend and build optimal screen flows.
• Requires process and application expertise and strong leadership skills to work with key personnel, end users, and project team members to identify and resolve issues throughout project phases.
• Will accept and complete new project assignments and will sometimes be asked to lead a project.
• Responsible for appropriately communicating project status and resolving and/or escalating issues where appropriate.
• Knowledgeable in multiple applications and has in-depth knowledge of how the supported applications integrate with each other.

Registered Nurse – PACU / OPS

Revenue Cycle Reimbursement Analyst

System Analyst, Clinical