Manager Of Clinical Audits

Description:

The Revenue Cycle Manger of Clinical Audit and Administrative Appeals is responsible for the development and management of programs related to regulatory reimbursement, including but not limited to the oversight of the Recovery Audit Contractor implementation and Medicaid Integrity Project, and the denial and appeal processes for emergency, outpatient, and inpatient encounters as performed by the Nurses and Claims Analysts for the JHH, JHBMC, HCGH, SMH, SH and ACH. The Manager also has direct responsibility for the Outsource Nurse, Administrative Coordinator and Staff Assistant processes that support RCM and the denial and appeal processes. This position reports directly to the Director of Appeals and Revenue Integrity and provides support for Payor Management and implements the organization’s regulatory reimbursement management plan in accordance with the mission and strategic goals of the organization, federal and state law and regulations, payer requirements and accreditation standards. The Manager also provides other JHM entities support in project planning and implementation along with supervising and recruiting departmental registered nurses.