Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory requirements. Responsibilities + Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors. + Educates department staff to issues related to the reimbursement process, as well as other concerns that result from monitoring activities. + Responsible for resolving issues as they occur. + Other duties as assigned. Requirements, Preferences and Experience Education Preferred: BSN or RN with BS/BA in Business Administration or Management Minimum: Diploma RN or RN AD Experience Preferred: PREFERRED 5 years of healthcare care experience and 3 years in Medicare billing environment. Previous audit experience, knowledge of InterQual and Medicare Billing practices. Minimum: Required 2 years of healthcare care experience as RN Licensure, Registration, Certification Minimum: RN Special Skills Minimum: Strong knowledge of state and federal healthcare laws and regulations. Understanding of CMS coverage and payment methodologies Training Minimum: Successful demonstration and detailed understanding of Hospital Revenue Cycle, CPT codes, HCPC codes, modifiers, and the Medicare/Medicaid Appeals Process. Familiarity of billing regulations including federal and guidelines. Must have excellent communication skills and proven ability to present. About Baptist Memorial Health Care At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey. At Baptist, We Offer: + Competitive salaries + Paid vacation/time off + Continuing education opportunities + Generous retirement plan + Health insurance, including dental and vision + Sick leave + Service awards + Free parking + Short-term disability + Life insurance + Health care and dependent care spending accounts + Education assistance/continuing education + Employee referral program Job Summary: Position: 12472 - Coordinator-RAC TPE Facility: BMHCC Corporate Office Department: HS Revenue Audit Corporate Category: Finance and Accounting Type: Non Clinical Work Type: Full Time Work Schedule: Days Location: US:TN:Memphis Located in the Memphis metro area REQNUMBER: 20621