Community Health Network

Title: Denials Management Registered Nurse (RN) Location: Indianapolis, IN 46256 Work Type: Remote, Full Time Job ID: 2602608 Job Description: Join Community Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, "community" is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered - and we couldn't do it without you. Make a Difference The primary role of the Denial Management Registered Nurse is to research, analyze, document and appeal third party payer denials involving medical necessity or clinical issues. The Denial Management RN will work from home after orientation completion, and is required to maintain productivity requirements set by leadership. Exceptional skills and qualifications - 5 years of clinical experience required. - 1-3 years Case management preferred. - 1-3 years experience with Third party payer (Medicare) preferred. - Previous Denials experience highly preferred. - Knowledge of Epic operating system preferred. - A working knowledge of the following: Utilization Management and Review, Clinical and Patient Financial Documentation Systems, Level of Care review, criteria Payer Appeals guidelines, Regulatory guidelines, Transitional Care (Required). License and Education - Graduate of National League for Nursing or Commission on Collegiate Nursing Education accredited school of nursing. Associates or Bachelor of Science in Nursing is required. - Licensed as a Registered Nurse by the Indiana Professional Licensing Agency required. Why Community? At Community Health Network, we build teams that deliver exceptional care through empathy, communication and collaboration. We consider ALL an integral part of the exceptional patient experience. We PRIIDE ourselves on not having employees but Caregivers. Join our Community as we make a difference in your community. Caring people apply here.

Role Description The Ambulatory Triage Registered Nurse functions as a member of the Family Medicine Care team, conducting duties such as: - Phone triage - Patient education - Scheduling appointments - Prior authorizations - Prescription refill - Referrals - Care coordination - Other related tasks as needed The nurse will primarily work from home once training has been completed and will support the Family Medicine Washington Pavilion office located on the east side of Indianapolis. Must reside in the Indianapolis area or surrounding counties. Qualifications - Graduate of National League for Nursing (NLN), Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), or National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA) accredited school of nursing, or three years of related professional nursing experience. - Licensed as a Registered Nurse (RN) with a valid license to practice in the state of Indiana as listed in the Nurse Licensure Compact (NLC). - Three years or more of nursing experience preferred. - Previous medical office/outpatient experience preferred. - Phone triage experience a plus. - Excellent communication skills. - Excellent team skills. - Compassionate and caring. - Accountable and self-directed. - EPIC experience a plus. Company Description Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you.

Join Community Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you. Make a Difference The Patient Account Representative is responsible for managing all aspects of accounts receivables to ensure maximum/timely reimbursement for services performed for hospital billing and claims. The patient account role will be responsible for keeping current on all payer specific regulations and procedures and will provide written summaries of findings and recommendations. This position is customer focused with emphasis on accounts receivable management. The Patient Account Representative is required to follow established guidelines, take action to recover delinquent accounts with the payers. Place calls to the payers to collect and assist in maintaining Network A/R days. Follow up maybe performed by way of payer websites when appropriate. This position will allow the flexibility to work from home upon completion of the initial training period. Your exceptional skills and qualifications • Two years or more years’ of experience in revenue cycle healthcare within a medium to larger healthcare system • Must be knowledgeable regarding payer billing guidelines • High School Diploma or GED required • Adheres to all network and departmental procedures and policies • Complies with applicable state/federal laws and the program requirements of accreditation agencies and federal, state and government health plans • Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others • Ensures confidentiality of patient records • Follows appropriate steps to resolve denials within specified timeframe • Follows appropriate steps to resolve insurance correspondence scanned into mail queues • Follows billing and collection procedures as outlined in policies and provides payers with the appropriate and necessary information to adjudicate claim • Maintains A/R to meet Network set goals • Meets productivity standards designated by the department • Meets QA standards designated by the department • Monitors the billing and follow up holds at all sources, ensures timely resolution and is responsible for keeping assigned tasks current • Participates in monthly conference calls with specific payers

Join Community Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you. Make a Difference The Patient Account Representative is responsible for managing all aspects of accounts receivables to ensure maximum/timely reimbursement for services performed for hospital billing and claims. The patient account role will be responsible for keeping current on all payer specific regulations and procedures and will provide written summaries of findings and recommendations. This position is customer focused with emphasis on accounts receivable management. The Patient Account Representative is required to follow established guidelines, take action to recover delinquent accounts with the payers. Place calls to the payers to collect and assist in maintaining Network A/R days. Follow up maybe performed by way of payer websites when appropriate. This position will allow the flexibility to work from home upon completion of the initial training period. Your exceptional skills and qualifications • Two years or more years’ of experience in revenue cycle healthcare within a medium to larger healthcare system • Must be knowledgeable regarding payer billing guidelines • High School Diploma or GED required • Adheres to all network and departmental procedures and policies • Complies with applicable state/federal laws and the program requirements of accreditation agencies and federal, state and government health plans • Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others • Ensures confidentiality of patient records • Follows appropriate steps to resolve denials within specified timeframe • Follows appropriate steps to resolve insurance correspondence scanned into mail queues • Follows billing and collection procedures as outlined in policies and provides payers with the appropriate and necessary information to adjudicate claim • Maintains A/R to meet Network set goals • Meets productivity standards designated by the department • Meets QA standards designated by the department • Monitors the billing and follow up holds at all sources, ensures timely resolution and is responsible for keeping assigned tasks current • Participates in monthly conference calls with specific payers

Perform clinical nutrition patient care, communicate effectively with healthcare teams, provide nutrition education, and implement care plans in accordance with physicians' requirements to ensure quality nutritional care for patients.

Join Community Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you. Make a Difference The Patient Account Representative is responsible for managing all aspects of accounts receivables to ensure maximum/timely reimbursement for services performed for hospital billing and claims. The patient account role will be responsible for keeping current on all payer specific regulations and procedures and will provide written summaries of findings and recommendations. This position is customer focused with emphasis on accounts receivable management. The Patient Account Representative is required to follow established guidelines, take action to recover delinquent accounts with the payers. Place calls to the payers to collect and assist in maintaining Network A/R days. Follow up maybe performed by way of payer websites when appropriate. This position will allow the flexibility to work from home upon completion of the initial training period. Your exceptional skills and qualifications • Two years or more years’ of experience in revenue cycle healthcare within a medium to larger healthcare system • Must be knowledgeable regarding payer billing guidelines • High School Diploma or GED required • Adheres to all network and departmental procedures and policies • Complies with applicable state/federal laws and the program requirements of accreditation agencies and federal, state and government health plans • Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others • Ensures confidentiality of patient records • Follows appropriate steps to resolve denials within specified timeframe • Follows appropriate steps to resolve insurance correspondence scanned into mail queues • Follows billing and collection procedures as outlined in policies and provides payers with the appropriate and necessary information to adjudicate claim • Maintains A/R to meet Network set goals • Meets productivity standards designated by the department • Meets QA standards designated by the department • Monitors the billing and follow up holds at all sources, ensures timely resolution and is responsible for keeping assigned tasks current • Participates in monthly conference calls with specific payers

Join Community Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you. Make a Difference The Patient Account Representative is responsible for managing all aspects of accounts receivables to ensure maximum/timely reimbursement for services performed for hospital billing and claims. The patient account role will be responsible for keeping current on all payer specific regulations and procedures and will provide written summaries of findings and recommendations. This position is customer focused with emphasis on accounts receivable management. The Patient Account Representative is required to follow established guidelines, take action to recover delinquent accounts with the payers. Place calls to the payers to collect and assist in maintaining Network A/R days. Follow up maybe performed by way of payer websites when appropriate. This position will allow the flexibility to work from home upon completion of the initial training period. Your exceptional skills and qualifications • Two years or more years’ of experience in revenue cycle healthcare within a medium to larger healthcare system • Must be knowledgeable regarding payer billing guidelines • High School Diploma or GED required • Adheres to all network and departmental procedures and policies • Complies with applicable state/federal laws and the program requirements of accreditation agencies and federal, state and government health plans • Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others • Ensures confidentiality of patient records • Follows appropriate steps to resolve denials within specified timeframe • Follows appropriate steps to resolve insurance correspondence scanned into mail queues • Follows billing and collection procedures as outlined in policies and provides payers with the appropriate and necessary information to adjudicate claim • Maintains A/R to meet Network set goals • Meets productivity standards designated by the department • Meets QA standards designated by the department • Monitors the billing and follow up holds at all sources, ensures timely resolution and is responsible for keeping assigned tasks current • Participates in monthly conference calls with specific payers

Role Description The Patient Account Representative is responsible for managing all aspects of accounts receivables to ensure maximum/timely reimbursement for services performed for hospital billing and claims. This position is customer focused with emphasis on accounts receivable management. - Keep current on all payer specific regulations and procedures. - Provide written summaries of findings and recommendations. - Follow established guidelines to recover delinquent accounts with the payers. - Place calls to the payers to collect and assist in maintaining Network A/R days. - Follow up via payer websites when appropriate. - Flexibility to work from home upon completion of the initial training period. Qualifications - Two years or more years’ of experience in revenue cycle healthcare within a medium to larger healthcare system. - Must be knowledgeable regarding payer billing guidelines. - High School Diploma or GED required. - Adheres to all network and departmental procedures and policies. - Complies with applicable state/federal laws and the program requirements of accreditation agencies and federal, state and government health plans. - Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others. - Ensures confidentiality of patient records. - Follows appropriate steps to resolve denials within specified timeframe. - Follows appropriate steps to resolve insurance correspondence scanned into mail queues. - Follows billing and collection procedures as outlined in policies and provides payers with the appropriate and necessary information to adjudicate claim. - Maintains A/R to meet Network set goals. - Meets productivity standards designated by the department. - Meets QA standards designated by the department. - Monitors the billing and follow up holds at all sources, ensures timely resolution and is responsible for keeping assigned tasks current. - Participates in monthly conference calls with specific payers. Company Description Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you.

Join Community Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you. Make a Difference The Innovative Healthcare Collaborative of Indiana (IHCI) is a joint venture between Community Health Network and Deaconess Health System. Its goal is to support our sponsors and partners in their strategic evolution to positively impact and improve the healthcare delivery system. This position is primarily REMOTE but there is potential for some physician office-based duties. Patient coordination will be telephonic. This role will provide both direct social work care management to various high-risk patient populations, as well as provide psychosocial, environmental and financial consultation to other members of the care team. You will serve as a critical member of the integrated care team. Exceptional Skills and Qualifications Applicants for this position should be able to collaborate with others in a team setting, have excellent communication skills, and a positive attitude toward problem-solving. - LSW or LCSW in the State of Indiana required. - Bachelor’s degree in social work required. - Master’s degree in social work preferred. - 2 years of experience providing social work services within a variety of population health and/or value-based care program settings preferred. - 2 years of knowledge of care resources for targeted populations. Comfort with technology including Microsoft suite of products. Prior experience using electronic health records including data capture, data mining and reporting required. - 3 years of medical or community Social Work experience providing patient-centered outreach, behavioral health services, needs assessment and support required. - Care Plan: Engages patients and caregivers in developing active care planning to focus on behavioral, clinical, social and environmental concerns and needs for the patient. Develops Plan of Care based on assessment to link patients to proper demographic resources. Connects patients with primary care, behavioral health, respite and other community- based services. Ensure that required data is accurate and consistently captured in the EMR. Acts as liaison and escalates clinical care issues to the IHCI RN Care Advisor when indicated. Communicates with nursing staff or situation that requires nursing judgment. - Resources: Develops and maintains a comprehensive inventory of local community resources, improving accessibility for patients and providers. Solid understanding of Medicare, Medicaid, and third-party payer guidelines for a comprehensive understanding of which community and governmental resources are covered for their patient. Links patients to local resources such as housing support, medication assistance, finance and insurance assistance, as well as other needed resources, as appropriate. - Assessment: Evaluates the needs of the patient through psychosocial, environmental, and financial assessment to determine specific social needs, make referrals and follow-up with patients weekly, and as needed. Assesses the patient’s knowledge of their clinical condition and provides education and self-management support based on the patient’s preferences and financial resources. - Advocate: Utilize a variety of outreach strategies to engage various patient populations. Obtains services and serves as advocate on behalf of patients.

Role Description This position is primarily REMOTE but there is potential for some physician office-based duties. Patient coordination will be telephonic. This role will provide both direct social work care management to various high-risk patient populations, as well as provide psychosocial, environmental and financial consultation to other members of the care team. You will serve as a critical member of the integrated care team. Qualifications - LSW or LCSW in the State of Indiana required. - Bachelor’s degree in social work required. - Master’s degree in social work preferred. - 2 years of experience providing social work services within a variety of population health and/or value-based care program settings preferred. - 2 years of knowledge of care resources for targeted populations. - Comfort with technology including Microsoft suite of products. - Prior experience using electronic health records including data capture, data mining and reporting required. - 3 years of medical or community Social Work experience providing patient-centered outreach, behavioral health services, needs assessment and support required. Requirements - Engages patients and caregivers in developing active care planning to focus on behavioral, clinical, social and environmental concerns and needs for the patient. - Develops Plan of Care based on assessment to link patients to proper demographic resources. - Connects patients with primary care, behavioral health, respite and other community-based services. - Ensures that required data is accurate and consistently captured in the EMR. - Acts as liaison and escalates clinical care issues to the IHCI RN Care Advisor when indicated. - Communicates with nursing staff on situations that require nursing judgment. - Develops and maintains a comprehensive inventory of local community resources, improving accessibility for patients and providers. - Solid understanding of Medicare, Medicaid, and third-party payer guidelines for a comprehensive understanding of which community and governmental resources are covered for their patient. - Links patients to local resources such as housing support, medication assistance, finance and insurance assistance, as well as other needed resources, as appropriate. - Evaluates the needs of the patient through psychosocial, environmental, and financial assessment to determine specific social needs, make referrals and follow-up with patients weekly, and as needed. - Assesses the patient’s knowledge of their clinical condition and provides education and self-management support based on the patient’s preferences and financial resources. - Utilizes a variety of outreach strategies to engage various patient populations. - Obtains services and serves as advocate on behalf of patients. Company Description Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you. The Innovative Healthcare Collaborative of Indiana (IHCI) is a joint venture between Community Health Network and Deaconess Health System. Its goal is to support our sponsors and partners in their strategic evolution to positively impact and improve the healthcare delivery system.