Graduate of a Bachelors of Science in Nursing program required.
Minimum of 3 years of clinical experience as a Certified Professional Coder required.
Three to five years of case management utilization review, or compliance related work experience in a hospital setting preferred.
Pediatric experience preferred.
Current knowledge of third party billing, appeals, regulatory and accrediting requirements required.
Exceptional analytical skills necessary to determine appropriateness of patient charges in relation to medical records and third party reimbursement.
Interpersonal skills necessary in order to communicate effectively with other professionals.
Demonstrates proficiency in MS Office and other health record management systems.
Knowledge of quality management methodologies, medical record documentation, compliance requirements and performance improvement system.
Demonstrates the ability to prepare reports and summaries.
