Medical Billing – Revenue Cycle - Resource Utilization Clinician
Location: Remote or On-Site
Annual Salary: $63,000
Full-Time
Work Schedule: Mo–Fr / 40-45 hours per week / 8 am–5 pm CST
Job Summary
The Medical Billing – Revenue Cycle – 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 (i.e.: 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
Why Choose Air Evac Lifeteam? As a leader in helicopter air ambulance services, Air Evac Lifeteam is one of Global Medical Response's (GMR) family of solutions. Our GMR teams deliver compassionate, quality medical care, primarily in the areas of emergency and patient relocation services. View the stories on how our employees provide care to the world at www.AtaMomentsNotice.com.. Learn how our values are at the core of our services and vital to how we approach care and check out our comprehensive benefit options at GlobalMedicalResponse.com/Careers.
EEO StatementGlobal 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. Notice of Nondiscrimination: https://www.globalmedicalresponse.com/docs/site/non-discrimination
Check out our careers site benefits page to learn more about our comprehensive benefit options, which include medical, vision, dental, 401k, disability, FSA, HSA, EAP, vacation and paid time off.
