Public Policy Manager
Persona
RAC Case Manager
OhioHealth
full-time
Posted on:
Location: Ohio • 🇺🇸 United States
Visit company websiteJob Level
JuniorMid-Level
About the role
- The position requires a diverse set of organizational skills, medical chart review and analysis, knowledge of claims appeal process and ability to apply Interqual, Milliman practice management guidelines to determine medical necessity and appropriateness of coding and billing; Must have the ability to research complex issues pertaining to Medicare reimbursement and payment policies; This position assists in development, implementation, refinement and reporting of the RAC case management and appeals program; It is accountable for reviewing documentation of clinical care provided, financial outcomes of an assigned population, coordinating clinical documentation, drafting appeal letters and identified for RAC audits and appeals in response to a claims denial from the RAC; He/She works collaboratively with all interdisciplinary staff internal to OhioHealth and also external organizations to achieve timely, cost efficient and effective management of the RAC case management appeals process
Requirements
- Associate's Degree (Required)
- RN - Registered Nurse - Ohio Board of Nursing
- RN from an accredited school of Nursing and currently licensed in the State of Ohio
- Field of Study: nursing or health related field
- Clinical expertise in a care setting with background in case management appeals and denials
- in coding guidelines
- Computer skills/data entry
- Data entry analysis skills
- Writing skills
- Staff RN Experience
- 2- 5 years nursing Experience in specialized nursing area
- Work Shift: Day
- Scheduled Weekly Hours : 40
- Department RC Clinical Audit Appeal Department
