JOB TITLE: Internal Review Coordinator, Registered Nurse
LOCATION: Fort Smith, Arkansas
FLSA STATUS: Exempt
SCOPE OF POSITION:
Responsible for analyzing patient records to determine legitimacy and necessity of medical services in compliance with government reimbursement policies. Review may be prior authorization, concurrent with service or post service. Review findings may be referred to a physician advisor for final determination.
ESSENTIAL JOB FUNCTIONS:
Review each selected record accurately and according to AFMC, state and federal policies and procedures.
Write effective and accurate review summaries and submit within appropriate time frame.
Refer all cases requiring additional review to the appropriate reviewer on a daily basis.
Maintain files for recording and reporting in accordance with established procedures.
Perform site surveys as required or directed.
Prepare monthly reports and/or statistics as directed.
Communicate effectively with internal and external clients.
Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.
Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
Additional duties as assigned.
Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices):
Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to travel as needed. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.
Required: Diploma or Associate’s degree in nursing.
Licensed as a Registered Nurse in the state of Arkansas.
Must successfully complete ICD-9-CM and CPT coding workbook within 90 days of employment.
Desirable: Bachelor’s degree in nursing.
Required: Three (3) years clinical nursing experience.
Desirable: Quality Assurance / Utilization Review and/or coding experience.
KNOWLEDGE, SKILLS, AND ABILITIES:
Intermediate level computer skills (Excel, Word, Access, PowerPoint and Outlook).
Type 50 wpm.
Exceptional skills in business English and spelling are required.
Ability to maintain confidentiality.
Strong oral and written communication skills.
Ability to meet deadlines.
Attention to detail.
Knowledge of ICD 9 Coding.
Knowledge of HIT/EHR.
Ability to work collaboratively and independently to achieve stated goals.
Ability to relate professionally and positively with staff, business partners, customers, constituents, recipients and the public.
Ability to multitask.
Ability to prioritize.
Strong organizational skills.
Problem solving skills.
Project management skills.
Ability to read, interpret and apply laws, rules and regulations.
Knowledge of quality improvement processes and techniques.
Time management skills.