Registered Nurse Job at Barton HealthCare System
Purpose Statement
Consistently Exceptional Care
Consistently Exceptional Care
Barton Health is a not-for-profit, equal opportunity employer and does not discriminate on the basis of sex, age, religion, creed, national origin, race or handicap in its relationship with patients, visitors or employees.
Mission
Barton Health is dedicated to the delivery of safe, high quality health care to community members and visitors. We are committed to compassionate, personalized, comprehensive and responsive treatment of all of our patients and other guests.
Barton Health is dedicated to the delivery of safe, high quality health care to community members and visitors. We are committed to compassionate, personalized, comprehensive and responsive treatment of all of our patients and other guests.
Nicotine Free Statement: To further our mission in providing quality, compassionate care to everyone, Barton Health will not hire individuals who use or test positive for nicotine or tobacco products. Barton Health promotes a healthy and safe environment for all Associates, Physicians, Volunteers, Patients, and Visitors. Therefore, all individuals whose pre-employment drug test results are positive for nicotine will have their job offer rescinded, and they will be disqualified from applying for employment for 6 months (180) days from the date of the health screening.
Drug Free Statement:
Barton is also a drug free facility, and as such Barton Health will not hire individuals who do not pass the drug testing requirement. If an individual is not cleared by the Medical Review Officer (MRO), the job offer will be rescinded and they will be disqualified for any future employment at Barton.
COVID Statement:
Since Barton is a healthcare provider in CA, under CDPH, all Barton employees must be fully vaccinated for COVID or have an approved medical or religious exemption and perform weekly testing.
Job Function: Nursing
Employment Type: Full-Time
Hours per Pay Period 1.00 (80 hours p/pp)
Job Shift: Day
Weekend/Holiday Rotation: No
Summary of Position:
This positions provides support for authorized audits, setting appointments, reviewing medical records, and meeting with auditors. Communicates audit results to necessary department heads for process improvement. Compiles reports of audit results and action plan. Assesses denials for appeal process, appeals denials, communicates denial information to necessary department heads for process improvement. Compiles reports of denials for inpatient and outpatient services and action plan. Educates the Barton staff and Medical Staff on utilization review requirements. Supports the efforts of the patient accounting department. Manages department audit reports and forms Ensures charges and reimbursements related to audits are complete
Qualifications
Education:
- Completion of an accredited Nursing program
Experience:
- Minimum of five years nursing experience in a hospital setting
- Minimum of 2 years of Utilization Review experience
- Denial management and audit experience preferred
- Sufficient computer skills as are required to complete an online application and the In compliance with patient safety standards, must be able to effectively communicate in English; Bilingual abilities preferred
Knowledge/Skills/Abilities:
- Acute care nursing
- Utilization management/review skills
- Commercial and Government Insurance knowledge
- Billing knowledge
Certifications/Licensure:
- Current California RN license or ability to obtain prior to start date
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is frequently required to walk, stand, sit, and talk or hear.
- The employee is occasionally required to use hands to finger, handle, feel or operate objects, tools, or controls; and reach with hands and arms.
- The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl.
- Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.
- The employee must occasionally lift and/or move up to 25 pounds.
Working Conditions
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Normal office environment. The noise level in the work environment is usually quiet to moderate while in the office.
- Occasional travel to various health system locations.
Essential Functions
- Provides consistently exceptional care at all times.
- Responds to Defense Audit requests in a timely manner.
Schedules Defense Audits and ensures BHS audit policy is provided.
Exercises judgment as to the urgency and nature of requests and ensures that all messages are relayed to the appropriate staff in a timely manner.
- Compiles audit result reports and communicates problems as they arise through proper channels.
- Performs assigned audit requests accurately and reports findings in a timely manner.
Internal Audits:- OTR, other types as requested
- Defense Audits
- Audit Spreadsheet Report
- Audit Result Reporting
- Revenue Opportunities Review
- Participates in designated meetings, upholds compliance standards, records findings, and reports information to required parties according to procedure.
- Maintains department defense audit forms and administrative files, collects fees from Auditors and forwards to PA Cashiering for crediting of account.
- Write appeal letters as needed and follow-up with insurance companies for payment.
Determine medical necessity for denials as needed and intervene when appropriate.
Assess status and obtain MD Order to change patient status as needed.
Identify documentation and billing errors and work with department managers to correct the errors.
- Identify charge master errors and works to resolve them.
- Compiles monthly denial reports
- Reviews Business Office write-offs for denial stats and intervenes as needed.
- Educates the Barton employees and Medical Staff on utilization Review Process and or process improvement ideas to assure payment for services provided to patient.
- Performs other related duties as assigned or requested.
- Observes all policies, procedures, laws and regulations as established by Barton HealthCare System, State and Federal law and/or other governing authority(ies)
- Keeps updated on all changes to hospital policies and procedures In compliance with HIPAA, respects and protects the confidentiality of all protected health information
- Maintains, respects and protects the confidentiality of proprietary information and competitive intelligence
- Obtains, maintains and provides documentation of completion on all required certifications and licensure prior to expiration (including Driver license and proof of current auto insurance where applicable.
- Responds to the needs of the department by performing other duties, as necessary.
Purpose Statement
Consistently Exceptional Care
Consistently Exceptional Care
Mission
Barton Health is dedicated to the delivery of safe, high quality health care to community members and visitors. We are committed to compassionate, personalized, comprehensive and responsive treatment of all of our patients and other guests.
Barton Health is dedicated to the delivery of safe, high quality health care to community members and visitors. We are committed to compassionate, personalized, comprehensive and responsive treatment of all of our patients and other guests.
Values/Standards
Barton Health commits to integrity, collaboration and excellence through the practice of our four Service Standards:
- Safety
- Respect
- Image
- Efficiency
Barton Health is a not-for-profit, equal opportunity employer and does not discriminate on the basis of sex, age, religion, creed, national origin, race or handicap in its relationship with patients, visitors or employees.
Please Note :
www.epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.