Appeals and Grievance Nurse Registered Nurse II PRN
Christus Health
- Houston, TX Loop, TX
- Permanent
- Full-time
- Focuses on the review and analysis of governmental denial rationales and provides appropriate medical necessity appeal services
- Review governmental contractors response letter in comparison to the medical records
- Communicates with facility regarding missing or insufficient medical documentation
- Review medical documentation for adherence to Medicare guidelines relating to inpatient services (or other Medicare issues) and draft appropriate appeal letters based upon professional clinical opinion as to the medical necessity of the services provided
- Research issues using federal or law, federal regulations, and relevant CMS policies Communicates with members of the healthcare team identifying root causes for potential denials
- Communicates with the CMO/VPMA regarding appeals and obtain signature for appeals
- Assures all discussions and appeals are filed timely
- Completes data entry in the Denial database for tracking, trends, and analysis
- Associate's Degree in Nursing
- RN License in state of employment or compact