RN - Prescreener - Hospital Bill Audit - Remote

Certilytics   Louisville , KY   Full-time     Nursing
Posted on May 23, 2023
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Tracking Code 052223

Job Description

Carewise Health helps organizations improve the personal health of employees and control heatlhcare costs. Our industry-leading health and wellness programs help members build the skills they need to achieve and substain optimum health.  Medical Bill Review ensures that health plans and self-insured employers are billed accurately for the care their members receive. Headquartered in Louisville, KY. 


Potential to be a remote position based on progression after the first 90 days

-Screens referred claims by reviewing the diagnosis, procedures, length of stay, areas of charges, patient age, type of bill, state regulations, customer expectations, and historical information for the facility.
-Route claims to appropriate product.
-Meet prescreen deadlines.
-Update facilities in the system as appropriate.
-Develop a working rapport with customers by responding to inquires in a timely manner with tact and understanding.
-Maintain effective communication with team members.
-Maintain open communication.-Generate production reports of screen claims.
-Other duties as assigned.

Carewise Health provides a generous benefits package including:

 Medical Insurance
 Dental Insurance
 Life Insurance
 Vision Insurance
 Paid Vacation
 Paid Holidays
 Paid Sick Days
 Short Term Disability
 Long Term Disability
 401K Plan With Company Match
 Tuition Reimbursement
 Employee Assistance Program

All benefits are effective on the first day of employment with the exception of tuition reimbursement and STD/LTD, which is effective after 90 days of employment.

Attention Staffing Agencies: This position is not open for agency submittals. Any candidate submitted without HR approval will be considered an applicant of Carewise Health, not the agency. All Agency Candidates must first be submitted to HR.

 EOE Disability/Veterans


Required Skills

-Diploma in nursing required (Associate or Bachelor’s degree in nursing preferred). 

-Must have an active & unrestricted registered nurse license in the state of employment or reciprocal state.
-Minimum of three years clinical hospital experience.

-Healthcare claim audit experience must be demonstrated

-Healthcare claim knowledge strongly suggested in the following areas: Medical Necessity, High Cost Specialty $ NOC Infusions, High-cost Implants & Supplies, One Day Admissions, Readmissions, ER Visits, End Stage Renal Disease and HAC/Never Events

-Considerable knowledge of CMS claim reimbursement regulations a plus

-Experience with payment platforms Facets, FEP and NASCO a plus

-Coding experience a plus
-Must have excellent verbal and written communication skills.

-Must be proficient in Microsoft Word and Microsoft Outlook.

-Must be detailed oriented.

-Must be able to work with deadlines.

-Must have ability to organize and prioritize competing duties.

-Proficient typing skills.

-Must be able to successfully complete any required pre-employment testing.

-Travel required for company, client or provider meetings

Job Location
Louisville, Kentucky, United States
Position Type

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