Revenue Cycle Medical Billing - Appeal - Resource Utilization Clinician

Revenue Cycle Medical Billing - Appeal - Resource Utilization Clinician

Location: Remote or On-Site

Annual Salary: $70,000

This position is bonus eligible

Full-Time, Work Schedule: Mo-Fr / 40-45 hours per week / 8 am-5 pm CST

Job Summary

The Revenue Cycle Medical Billing - Appeal - Resource Utilization Clinician provides medical necessity justification for air transport evaluation and evaluation/submission of all medical necessity appeals for Medicare, Medicaid and Workers' Compensation payors. They utilize clinical experience and establish clinical standards and protocols to validate air medical necessity and appeal payment denials.

Essential Functions/ Duties

• Conducts the medical necessity appeals for all payor sources as the advocate for the patient and GMR.
• Receives the appeal request from the Appeal Prepper and inputs the information into data base.
• Ensures appeal timelines are met by moving the assigned book of business through the appeals process and updates appeals database.
• Works with fixed deadlines and demonstrates willingness to meet and exceed performance metrics.
• Collaborates with the Appeal team to determine the best approach to each clinical denial to maximize claim reimbursement and minimize the financial risk to patients and GMR.
• Maintains strict confidentiality of all protected health information and cooperates fully with all information security guidelines related to the scope of work.

Qualifications

Required Experience:

• Minimum of five years in Emergency department (ED), Intensive Care Unit (ICU), flight or ambulance experience or job experience equivalent
• Experience with researching EMS protocols, hospital referrals, clinical charts, and standards of care
• Proficient in Word, Excel, Office 365

Preferred Experience:

Supervisory/leadership experience preferred (ie: team leader, FTO, charge nurse, preceptor, educator, etc.)

Education/Licensure:

• Nurses
  • Current RN licensure, is required
  • Bachelor's degree in nursing or equivalent, in preferred
  • CFRN, CEN or CCRN, is preferred
• Paramedics
  • Current NREMT-P, is required
  • Associate's degree in EMS/related field or two years of college, is preferred
  • FP-C, CCP-C or CP-C, is preferred

Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability.

Check out our careers site benefits page to learn more about our benefit options.