Nurse Utilization Review occupation at ZOLL Medical Corporation in Pittsburgh

ZOLL Medical Corporation is currently seeking to employ Nurse Utilization Review on Tue, 23 Apr 2013 08:00:56 GMT. The Nurse Utilization Review responsibilities support the overall reimbursement department and processes. The audit & compliance analysts, which they are responsible for, are an integral part of the reimbursement team and has primary responsibility for the timely review of Commercial, Medicaid and Medicare accounts for clinical and compliance requirements prior to billing as well as conducting...

Nurse Utilization Review

Location: Pittsburgh Pennsylvania

Description: ZOLL Medical Corporation is currently seeking to employ Nurse Utilization Review right now, this occupation will be placed in Pennsylvania. Detailed specification about this occupation opportunity kindly see the descriptions. The Nurse Utilization Review responsibilities support the overall reimbursement department and processes. The audit & compliance analysts, which they are responsibl! e for, are an integral part of the reimbursement team and has primary responsibility for the timely review of Commercial, Medicaid and Medicare accounts for clinical and compliance requirements prior to billing as well as conducting internal audits to ensure policies and procedures for both insurance carriers and ZOLL are being met.

Required Skills

Training and support of the compliance and reimbursement department staff:

New hire orientation, review of duties and initial training

Review of Compliance analyst work and provide feedback for the first 30 days of their employment. May continue longer if necessary.

Conduct internal training as needed for reimbursement staff.

Audits, Internal and External:
Review and respond to internal and external audits of patient accounts/claims.

Track audits both internal and external on audit database.

Track audit results and report them to the Manager of Aud! its & Compliance.

Assist Manager with daily, weekly a! nd/or monthly reporting responsibilities.

Clinical review:
Provide Audit & Compliance analysts support with audit management and workflow.

Provide education and guidance where needed to Audit & Compliance analysts.

Provide support to reimbursement and sales with clinical questions as needed.

Carry a workload of audits and reviews.

Act as the point of contact for issues of moderate complexity relative to patient accounts

Identify areas of opportunity to improve processes along with aiding in the implementation of those changes.

Performs other duties as directed by Management.

Supervisory Responsibilities

Delegation/management of work to Compliance Analysts

Plan/Prepare for coverage of open positions which may include time off for specialists or vacancies due to position openings.

Assist the manager with employee feedback, corrective action and annual review process. !

Assist the manager with regular employee quality reviews.

Assist the manager with various reporting duties.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully. Utilizes available tools and resources effectively.

Judgment - Exhibits sound and accurate judgment.

Planning/Organizing - Uses time efficiently. Is able to prioritize team responsibilities effectively.

Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required Experience

Educatio! n and/or Experience

H.S. Diploma or equivalent required, Assoc! iate’s or Bachelor’s degree in nursing, business, finance or related field preferred

RN/NP/PA specializing in cardiology.

3-5 years experience in medical billing and insurance verification.

Strong negotiation skills and experience working with all payer types to include Medicare, Medicaid, and third party commercial insurance companies.

Superior communication and customer service skills and the ability to handle multiple tasks simultaneously under strict deadlines.

Experience in provider appeals with all payer types.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to ZOLL Medical Corporation.

If you interested on this occupation just click on the Apply button, you will be redirected to the official website

This occupation starts available on: Tue, 23 Apr 2013 08:00:56 GMT

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