Quality Review Nurse PHX
THIS JOB HAS EXPIRED Description
PHX is the leader in clinical bill review and audit, utilizing state-of-the-art technology and a team of experienced nurse auditors who perform pre-payment desktop audits on inpatient and outpatient medical claims.
PHX's approach to bill review and audit combines a clinical and financial approach to determine appropriateness of billing, uncovering data entry or pricing errors; unbundling; inappropriate, unsubstantiated or improper charges; cost to charge ratio analysis; never event identification; experimental/investigational reviews; and other practices that inflate billed amounts.
Our staff represents over 175 years of combined experience in auditing, utilization review and case management. This expertise combined with their payer, provider and clinical backgrounds, enables them to review claims efficiently and uncover substantial opportunities for cost savings.
We are seeking a Quality Review Nurse to manage the non-accept process as well as ensure overall quality and efficiency of claim turnaround.
Evaluate current non-accept process and be responsible for processing all ?non-accepts? on a daily basis that have been submitted by Nurse Auditor staff. Apply QA process to ensure complete & accurate audit and to ensure that all savings opportunities have been exhausted
Review current departmental policies and procedures. Create & deploy any necessary new policies as it relates to the Bill Review department.
Perform Audit duties of a Nurse Auditor when needed.
Other duties as needed by Director Bill Review and Audit.
Maintain awareness of and ensure adherence to PHX standards regarding privacy.
Qualified candidates will need to have the following credentials and skills:
LPN or RN in the State of New Jersey required
5 years of auditing, claims, review and/or billing experience with a health care organization required.
Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs.
Clinical skills to evaluate appropriate Medical Record Coding.
||Bedminster, NJ |
THIS JOB HAS EXPIRED