The Clinical Appeals Nurse is responsible for reviewing medical records and preparing clinical appeals to address medical necessity denials and DRG reassignments. They also participate in Administrative Law Judge hearings and collaborate with hospital clients to provide updates on appeal outcomes.
Review and evaluate electronic medical records for emergency department admissions to ensure medical necessity using clinical criteria. Participate in telephonic discussions with physicians and transmit clinical review information to insurance companies for authorization.
The Utilization Review Nurse evaluates electronic medical records for emergency admissions to ensure medical necessity using InterQual or MCG criteria. They also participate in telephonic discussions with physicians and enter clinical review data for insurance authorization.
The Certified Coder is responsible for daily coding, auditing, and DRG validation to ensure accuracy and compliance with outpatient standards. They also assist in responding to payer and governmental audits while maintaining expertise in current coding guidelines.
The IT Systems Administrator is responsible for the provisioning, configuration, and maintenance of enterprise infrastructure systems to ensure reliable business operations. This role involves administering server, network, and storage environments while collaborating with teams to troubleshoot issues and implement system enhancements.
Lead and coach a team of Solution Consultants to deliver high-impact sales presentations and product demonstrations. Manage demo environments and contribute clinical expertise to bid submissions and RFP responses.
The Senior Client Development Executive is responsible for generating new business through prospecting and consultative selling to prospective Netsmart clients. They will manage the full sales cycle, including lead qualification, solution planning, and the completion of RFPs.
Review OASIS documentation and ICD-10 coding to ensure accuracy, compliance, and quality in patient charts. Document recommended changes and their impact on reimbursement while meeting quality metrics and deadlines.
Identify and close strategic revenue cycle opportunities with large health systems and provider organizations. Act as a trusted advisor to C-suite executives to improve financial performance and operational efficiency through subscription-based services.
