RN Clinical Reimbursement Specialist - Days

INTEGRIS Health, Oklahoma’s largest not-for-profit health system has a great opportunity for a RN Clinical Reimbursement Specialist in Oklahoma City, OK.  In this position, you’ll work 8a-5p, Full-time, with our team providing exceptional care to those who have entrusted INTEGRIS Health with their healthcare needs. If our mission of partnering with people to live healthier lives speaks to you, apply today, and learn more about our increased compensation plans and recently enhanced benefits package for all eligible caregivers such as front-loaded PTO, 100% INTEGRIS Health paid short-term disability, increased retirement match, and paid family leave. We invite you to join us as we strive to be The Most Trusted Partner for Health.

The RN Clinical Reimbursement Specialist is responsible for identifying and preparing clinical appeals for government, managed care organizations, and various other payors. Provides assistance and guidance in the maintenance of the charge description master for the INTEGRIS Health system. INTEGRIS is an Equal Opportunity/Affirmative Action Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

The RN Clinical Reimbursement Specialist responsibilities include, but are not limited to, the following:

• Assists the Director of Revenue Recovery in the training and development of all INTEGRIS recovery staff related to clinical and non-clinical payment issues
• Oversees and manages the INTEGRIS System clinical denial management process
• Identifies inaccurate and/or problematic denial and payment trends and assists with the development of a plan to insure facilities receive maximum reimbursement
• Participates in Utilization Management Committee for all INTEGRIS facilities to report denial issues and develop preventive strategies in collaboration with the physicians
• Analyzes, prepares and distributes monthly denial reports to Vice Presidents, Directors and Managers of specified hospital departments
• Responds to utilization management clinical denials issued by government contracted vendors for the Medicare and Medicaid programs
• Supports Case Management and other hospital departments with clinical expertise in regards to both payor and patient clinical denial inquiries
• Assists the Chargemaster Consultant in the development, implementation, maintenance and audit functions related to the chargemaster description master.
• Analyzes denial trends for documentation or charging issue opportunities and facilitates cross-departmental collaboration to improve processes and develop best practices.
• Identifies charging, coding or clinical documentation issues and works with ancillary departments to resolve issues and notify appropriate leadership.
• Educates and maintains effective and practical knowledge of government and managed care payer rules, regulations and requirements.

Reports to assigned Corporate Manager. This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information. Minimal. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

• Current licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state. And 8 years' experience working with healthcare facilities, health insurance or managed care companies, and 10 years demonstrated experience working with healthcare facilities, health insurance or managed care companies 
• 6 years of direct managed care or case management experience 
• Knowledge and proficiencies with government rules and regulations, managed care contracts, provider relations, pre-certification, reimbursement, financial analysis, and patient accounting 
• Knowledge of legal documents, collection agency procedures, and contract documents 
• Must be able to communicate effectively in English (Verbal/Written)