Nurse Coordinator – PreServices

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

⏰ Full Time

🟢 Junior

🦅 H1B Visa Sponsor

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👻 Ghost score 10%

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Trinity Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

📚 Education

🤝 Non-profit

Healthcare • Education • Non-profit

Trinity Health is a Christian K-12 educational institution located in Wichita, Kansas, dedicated to providing a Christ-centered education that nurtures spiritual growth and academic excellence. The academy emphasizes the importance of faith in students' lives, integrating spiritual development with rigorous academic programs and a broad array of extracurricular activities, including athletics and fine arts. Trinity Health fosters a supportive community where teachers and families collaborate to help students develop a personal relationship with Jesus Christ and excel in their studies.

📋 Description

• Plan and provide professional nursing services in accordance with nursing standards, education, experience, Ohio nursing requirements, and established policies • Review pre/post service initial denials • Secure escalated insurance authorizations • Handle escalated medical necessity reviews • Coordinate with Patient Access, Mid-Revenue Cycle, and Patient Business Service to identify revenue optimization and denial prevention opportunities • Collaborate with physician providers to align proposed service intensity with severity of illness and support level-of-care determinations and authorizations • Investigate denials and root causes • Track and report denial trends to support remediation and internal process improvement • Research and apply regulatory policies to support administrative appeals • Coordinate denial management processes, including administrative/technical accounts and operational write-offs • Track initial denials and collaborate with Patient Access and Revenue Cycle colleagues on education and stakeholder reporting • Maintain required competencies, licenses, and certifications and support the learning and development of others

🎯 Requirements

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

🏖️ Benefits

• Medical, dental, and vision 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 • DailyPay, allowing eligible colleagues to transfer earned pay before payday • Diversity, Equity, and Inclusion Colleague Resource Groups