Part Time NTPF Claims and Utilisation Nurse
Job Purpose
This position will be to promote and preserve the Hospital mission, values (Human Dignity, Integrity, Compassion, Stewardship & Service) and ethos by effective delivery of mission objectives in your capacity as NTPF and Claims Utilisation Nurse.
Key Duties and Responsibilities:
* Promotes and preserves the Bon Secours Mission, Values & Ethos.
* Provides on-going completion of Consultant clinical documentation to ensure timely claim form submissions within agreed target guidelines.
* Completion of supporting consultant documentation to ensure billing is completed accurately and in line with consultant contract.
* Review part paid claims and completion of appeal letters where claim has not been paid in full.
* Develop relationships with consultants, hospital departments, including IT to identify potential improvement opportunities.
* Establish and maintain review meetings with Consultants or their supporting staff to discuss and improve KPIs, denial trending and any documentation issues.
* Communicates in a way that promotes trust and credibility between the revenue cycle functional teams and consultants and hospital leadership and strives to strengthen local and facility relationships for positive outcomes.
* Develop and maintain relationships with NTPF Co-ordinator, NTPF, referring hospitals liaison offices and Consultant medical staff and their secretaries.
* Assist the NTPF coordinator with the interpretation of clinical referral data and advise the co-ordinator on the appropriate referral pathways.
* Assist the NTPF co-ordinator with the description and definition of outliers and provide advice on the clinical justification of same.
* In liaison with the BSHD Finance Department, assist the NTPF Co-ordinator and Administrative Team in the collation of NTPF discharge summaries and hospital accounts for submission to NTPF.
* Assist the NTPF co-ordinator and Administrative Team in patient bookings and the full and accurate completion of NTPF discharge summaries.
* Following up with consultants regarding outstanding discharge summaries and delayed discharge summaries generated for referring hospitals.
* Escalates issues to direct leader as necessary to ensure timely resolution.
Essential Qualifications:
* Leaving Certificate or equivalent
Desirable Qualifications:
* Higher Diploma in business or related subject
* 3-5 years general nursing experience
* 3-5 years’ experience in Hospital billing, Consultant billing, or Insurer claims processing.
* Excellent communication skills with clear presentation and reporting ability
* Strong and demonstrated analytical and problem-solving abilities
* Demonstrated proficiency Microsoft Excel, and other Microsoft Office Suite applications.
* Service-oriented and proactive team player
* Ability to develop strong co-operative working relationships
* Able to motivate and challenge team members
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