The UMass Memorial Medical Center is the award-winning clinical partner to the University of Massachusetts Medical School and part of the largest non-profit health care system in Central and Western Massachusetts.
Position Summary:Demonstrates successful appeal and audit responses to third-party payers concerning hospital clinical and bill claim denials. Serves as an educational resource for staff and physicians to reduce or eliminate denials. Position Qualifications:Massachusetts licensure as registered nurse required. Knowledge of CPT and ICD-9-CM required. Thorough knowledge of HIPPA, Medicare and Medicaid compliance regulations.Third party payer and billing system knowledge preferred. Ability to effectively use specialized computer based systems for gathering, reporting, and analysis of clinical data. Excellent organizational and communications skills required.Preferred: Knowledge of CMS billing and compliance regulations in the acute care setting, third party payer process, and Utilization Management experience.Required: RN licensure, knowledge of CPT and ICD-9 coding, excellent communication and organizational skills.