Transplant Nurse Consultant

Ready to make a difference for hospitals while working from home? Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We’re powered by people, driven by technology, and dedicated to our clients and employees. If you’re looking for a collaborative and diverse culture with a great work/life balance, look no further. Revecore Perks:We offer paid training and incentive plansOur medical, dental, vision, and life insurance benefits are available from the first day of employment We enjoy excellent work/life balance Our Employee Resource Groups build community and foster a culture of belonging and inclusion We match 401(k) contributions We offer career growth opportunities We celebrate 12 paid holidays and generous paid time off Location: Remote-USA The Role: Nurse Consultant Primarily responsible for conducting a thorough review of medical records and other documentation to determine appropriate billable services, enabling the hospital to construct appeals for payment based on medical necessity or payer-specific guidelines—specifically for transplant-related appeals. Responsible for providing clients trending, revenue cycle fail point analysis, and best practice remediation recommendations. Training: Our comprehensive training begins on your first day and lasts 90 business days. It is led by instructors and incorporates interactive discussions and hands-on activities to accommodate diverse learning preferences. As a Nurse Consultant, you will:Build strong, lasting relationships with clients, payors and Revecore personnelAnalyze medical records or other medical documentation to validate services, tests, supplies and drugs performed for accuracy related to billing for services renderedIdentify and interpret medical, radiological, laboratory or other tests and procedures as well as pharmaceutical drugsReview and understand managed care contracts, hospital billing statements/bills and insurance denialsResearch commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims.Perform research regarding denials and effectively communicate information to associates, colleagues, managers and clientsContact insurance company to obtain missing information, explain and resolve underpayments and/or denials and arrange for payment or adjustment processing on behalf of clientPrepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment postingPerform denial trending for clients, identify fail points within the revenue cycle and on the payer side, and provide best practice recommendations to clients and Revecore managers.Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other Revecore personnelMaintain confidentiality of information in compliance with company policy and HIPAAAttend client, department and company meetingsLead client meetings and perform consulting services to client’s as it relates to medical necessity of services performed and proper vetting of payers criteriaIs this role for you? Revecore encourages our employees to be driven and highly motivated to be successful. We get excited by candidates who: College degree or diploma from school of nursing – must be RNClinical nursing experience working in hospital environment, preferably in ER, Critical Care or diagnostic servicesMinimum 5 years of related experience and/or training in utilization review or patient accounting Highly proficient in InterQual and MCG guidelines, with demonstrated ability to apply them appropriately in transplant claim appeal arguments.Understand patient accounting documents – UB04, EOBHave a working knowledge of Microsoft Office (Word, Excel, Outlook) Possess technical proficiency to work on multiple computer screens and software applications simultaneously Are able to read and interpret an extensive variety of documents such as medical records, patient care systems, instructions, policies and procedures in written (in English) and diagram formCan maintain strong performance in a fast-paced environment with productivity metrics Have strong analytical skills, attention to detail, and problem-solving skills to identify underpayments and discrepanciesHave experience with healthcare billing software and databases (EPIC, Cerner, Meditech)How we’ll set you up for success:Extensive multi-week training with ongoing support from teammates following training. Access to a robust knowledgebase for continued reference in your role. Visibility to your individual performance metrics enables you to set goals. Computers and necessary work equipment are provided Involved management who leans in to support your productivity metrics. Work at Home Requirements:A quiet, distraction-free environment to work from in your home. A secure internet connection is required. Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive. Revecore is an equal opportunity employer that does not discriminate based on race, color, religion, sex or gender, gender identity or expression, sexual orientation, national origin, age, disability status, veteran status, genetic information, or any other legally protected status. We believe that a diverse workforce fosters innovation and creativity, enriches our culture, and enables us to better serve the needs of our clients and communities. We welcome and encourage individuals of all backgrounds, perspectives, and abilities to apply. Must reside in the United States within one of the states listed below: Alabama, Arkansas, Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Maryland, Michigan, Minnesota, Missouri, Mississippi, Montana, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Wisconsin, and West VirginiaOriginally posted on Himalayas

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