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City Atlanta
State/Province Georgia [GA]
Title Nurse Analyst
Position Overview As a member of our team, the Nurse Analyst will join a successful team of professionals that provide consulting services to ambulatory care, acute care and post-acute care organizations including: documentation review and improvement and regulatory compliance for Medicare, Medicaid and third party payers. This individual serves as a dedicated team member who consistently demonstrates integrity and a strong client-oriented work ethic within a professional environment. For more information about Pershing Yoakley & Associates, please visit www.pyapc.com/careers.
Responsibilities •Current Georgia license of LPN or RN.
•A minimum of five (5) years prior experience in Acute Care medical necessity review/utilization review.
Requirements To qualify for consideration, successful candidates must have:
•Adept knowledge in McKesson InterQual and/or Milliman, Excel, Word and working knowledge of Medicare A&B.
•Strong research and interpretation abilities of National Coverage Determination and Local Coverage Determination
•Comprehensive skill and knowledge in medical documentation review for:
-Medical Necessity
-Level of Care
-Appropriateness of service and service location
-Billing documentation requirements and analysis of UB-04, Remittance Advices and Itemized Bills
•Areas of service: Acute Care Services – Inpatient and Outpatient services; Rehabilitation Services; Behavioral Health
•Superior communication skills are required, both oral and written.
•Limited regional travel.
•A strong work ethic with high level of initiative and motivation.
•Conscientious and focused in approach to work.
•Be polished, professional, and have a positive attitude.
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