Purpose:
The Clinical Appeals & CDI Manager will work in conjunction with the Director of Clinical Appeals to oversee the various functions of the Clinical Appeals Department for Managed Resources, Inc. The Managers responsibilities include review of appeal letters according to established company parameters, assists in quarterly audit reviews of nurses with the Director of Clinical Appeals, assists with quarterly reports for clients and attends meetings as needed, attend management meetings as needed via Skype, coordinates staff meetings with the Director, maintains a work queue of assignments, and other duties as needed if Director is unavailable.
Reports to:
Director of Clinical Appeals
Essential Job Functions:
Complete the following functions in accordance with Managed Resources policies:
The Clinical Appeals & CDI Manager will report directly to the Director of Clinical Appeals.
Reviews clinical appeal letters as designated by the Director of Clinical Appeals.
Assists Clinical Appeal Nurses as needed with questions, research, etc.
Assists Director with nurse audits as needed on a quarterly basis.
Assists with nurse assignments of client projects.
Ensure employee compliance with HIPAA regulations/training as required.
Assists the Director of Clinical Appeals with data gathering for month end and quarterly reports as needed.
Attends client meetings as needed and/or required.
Assists with reviewing appeal letters as necessary.
Provides input on content and direction of staff meetings.
Assists with yearly performance evaluations of Clinical Appeal Nurses.
Maintains personal work queue.
Education and Experience:
Registered Nurse (BSN preferred) or Physician, Previous management experience preferred
CCS; CDIP and/or CCDS preferred
Clinical Documentation Improvement (CDI) experience
DRG and Coding Appeal writing experience
Knowledge of CMS rules and regulations and third party payer requirements for reimbursable care
Excellent written and oral communication skills
Proficient in Microsoft Office
Ideal candidate will possess the following:
Ability to examine financial and clinical data trends and provide recommended action plan.
Integrity and commitment to excellence.