Job Description

"Responsible for handling administrative and medical appeals that require clinical input or interpretation, directing and coordinating all aspects of denied claims, provide coordination of comprehensive clinical documentation to third-party payers and state agencies to secure accurate payment, and the ability to identify coding or clinical documentation issues. "

1. Analysis and Recommendations
   1. Provides on-going trend analysis to identify reasons for denials and apply corrective actions steps to prevent cash flow retardation.
   2. Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Responsible for facilitating the internal appeal process.
   3. Actively works through denied claims and attempts to gather information and take appropriate action to ensure claim is adjudicated properly.
2. Quality
   1. Promotes the quality and efficiency of his/her own performance through participation in staff educational programs, approved continuing education courses, and specialized skill training programs.
   2. Utilizes all equipment, supplies, facilities, and resources in a prudent and efficient manner in order to ensure efficient departmental operations and the provision of high-quality health care services.
3. Other Duties as Assigned
   1. Performs other duties as assigned or requested.

Education - Graduate of accredited school of nursing

Licensure - Current Louisiana State license as RN