[Hiring] Nurse Coordinator PreServices @Trinity Health

Role Description

The licensed Registered Nurse (RN) plans & provides professional nursing services & standards of practice in accordance with level of experience & education, state board of nursing & established policies & procedures. The RN integrates the art, science, leadership & knowledge of the nursing clinical practice through relationship centered, compassionate, ethical & respectful direct / indirect healthcare services.

• Acts independently & appropriately within license, scope of knowledge & experience in practice area.
• Continues to evolve with best evidence discoveries.
• Provides leadership & retains accountability for delegation, choices, decisions & outcomes.
• Collaborates with key stakeholders & contributes to quality & improvement practices & outcomes.
• Exhibits willingness to take on new & additional responsibilities.
• Embraces new ideas & cultural differences while managing competing priorities.
• Knows, understands, incorporates & demonstrates standard elements of professional practice: Assess, Diagnose, Outcomes Identification / Solutions, Plan, Implement, Evaluate.
• Participates in own professional development by maintaining required competencies, licenses & certifications.
• Supports the learning & development of others (e.g., staff, formal learners, patients, families, community).
• Incorporates caring process (Caritas), advocacy & appropriate resource utilization as an essential component of nursing practice.
• Practices in an environmentally safe, professional manner; monitors & initiates corrections or evidence-based practices.
• Maintains a working knowledge of applicable federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct.

Qualifications

• Graduation from an accredited school of nursing. Bachelor's degree preferred.
• Valid Ohio RN license.
• 1-2 years' experience of technical and/or clinical denials (i.e., medical necessity, eligibility issues, no authorization).
• Medical terminology and medical record coding experience (ICD-10, CPT/HCPCS).
• Certification and/or membership in AAPC, AHIMA, HFMA, AAHAM, NAHAM - preferred.
• Working knowledge of Epic Prelude and Resolute - preferred.
• Knowledge of and experience in case management/utilization management and managed care contracts - preferred.
• Knowledge of insurance and governmental programs, regulations, and billing processes (e.g., Medicare, Medicaid, managed care contracts and coordination of benefits is required).

Requirements

• Reviews pre/post service initial denials, securing escalated insurance authorizations.
• Handles escalated medical necessity reviews, and coordinates with Patient Access, Mid-Revenue Cycle and Patient Business Service (PBS).
• Investigates denials and root causes and tracks and reports trends to remediate issues and assist with internal process improvement.
• Leverages clinical knowledge and standard procedures to ensure timely attention to denials as requested by PBS.
• Assists in the research and application of regulatory policies to support administrative appeals.
• Coordinates denial management processes focusing upon process improvement and resolution follow-up.
• Ensures tracking of initial denials identifying trends and collaborating with other Patient Access and Revenue Cycle colleagues for education and reporting to key stakeholders.

Benefits

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday.
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.