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Director Revenue Cycle / Prior Authorization (RN)
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Full-time
- The prior authorization nurse reviews requests for medical treatments, services, or procedures to determine whether they qualify for insurance coverage.
- Director will have oversight and planning for HIM management for inpatient, outpatient, and physician services records and coding; Monitors HIM goals intradepartmental and Revenue Cycle; Implements processes and strategies for the HIM department including scanning, Release of Information, duplicate medical records, transcription, and coding; Collaborates with hospital departments and ambulatory clinics, interacting with internal and external customers, to build relationships and achieve results;
- Communicate with providers and members regarding status of authorization requests Collaborate with centralized Authorization specialist to ensure bi-furcation process of information submitted to payers Review and Research Authorization denials in collaboration with PFS and other teams, as necessary.
- Develop and maintain controls within Health Information Management (HIM); Directs and develops high functioning operations and coding teams that includes manager, supervisor and team lead levels that support delegation and oversight.
- Continually assess and develop an organizational structure that supports high performance results Monitors and reports on key metrics including, but not limited to: Coding AR days in HB and PB, Release of Information turnaround, transcription turnaround, and coding accuracy Completes monthly trending analyses and presents findings at monthly operational review meetings to senior revenue cycle leadership.
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