This position performs specialized administrative duties pertaining to utilization review, audit, billing and reimbursement activities, utilizing knowledge of both nursing and administrative practices. Assists in the coordination of billing audits with third party agencies, and as requested by BTNRH administrative team. Conducts concurrent reviews of billings for selected discharges and performs managed care defense audits and under/over charge audits; reviews charge-related patient grievances; reviews denied charges, recommends appeals and/or facilitates the resolution of root causes where appropriate; communicates audit and analysis findings to various parties. Assists the CBO management team with the analysis, development, generation and presentation of information critical to the measurement and ongoing trending of various aspects of the BTNRH revenue cycle. Responsible and accountable for the management of utilization review through ensuring timely review of all hospital admissions and insurance authorization. Collaborates with Medical Director for education of review process for medical staff and Boys Town physician leaders.
Associate or Bachelor's degree in Nursing, with a current state registered nurse license, required.
Minimum of five years in compliance and/or medical auditing, coding, utilization review, and/or other related healthcare experience, required
Minimum of five years of clinical experience with an emphasis in Pediatrics, required.
Minimum of five years of experience involving decision-making with knowledge of utilization review activities, applying InterQual criteria, preferred.
Active certified coder, preferred.
Extensive knowledge and understanding of ICD-9-CM/ICD-10-CM, CPT-4, NCPCS Level II, and Revenue Code assignments.
Good communication, assessment, and organizational skills.
Good PC skills including experience with Microsoft Outlook, Word, and Excel.
Good public relation skills and detail oriented.
Background in Medicare, Medicaid, Third-party billing, compliance and reimbursement regulations, preferred.
Experience with billing and EMR software applications as they apply to the computerized patient record.
Excellent benefit package that includes health, dental and vision insurance; a 401k retirement plan; paid vacation and sick leave. Boys Town National Research Hospital is a tobacco free campus. This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town National Research Hospital is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. To request a disability-related accommodation in the application process contact us at 1-877-639-6003.
Internal Number: 6498
About Boys Town National Research Hospital
Since the opening of Boys Town National Research Hospital in 1977, the hospital has been internationally recognized as a leader in clinical and research programs focusing on childhood deafness, visual impairment and related communication disorders. We have developed national medical programs that are now instituted in hospitals and clinics across the country.
Today, the hospital offers a broad range of clinical services, including ear, nose and throat services at the Boys Town Ear, Nose and Throat Institute, general pediatric care with Boys Town Pediatrics, and orthopaedic, internal medicine, pediatric gastroenterology, allergy, asthma, pediatric pulmonology, behavioral health, audiological and ophthalmologic care.
The hospital has expanded to offer surgical and clinical services at two Omaha locations: 555 North 30th Street in Omaha and 14000 Hospital Road on the campus of Boys Town, Nebraska.
Boys Town National Research Hospital has assembled national leaders in research who are making important contributions in the areas of genetics, hearing, language, vision and speech disorders. Applying these findings with new technologies, distance learning and the exploration of ne...w research frontiers, the opportunities for new medical diagnoses, evaluation and treatment discoveries are endless.
Accredited by The Joint Commission, Boys Town National Research Hospital is dedicated to providing leading edge clinical care, pioneering translational research and improving the lives of children and their families through applied technology and educational outreach programs. The hospital annually serves more than 40,000 children and families from across the United States.