Navigant Consulting, Inc. (NYSE: NCI) is a specialized, global professional services firm that helps clients take control of their future. Navigant's professionals apply deep industry knowledge, substantive technical expertise, and an enterprising approach to help clients build, manage and/or protect their business interests. With a focus on markets and clients facing transformational change and significant regulatory or legal pressures, the Firm primarily serves clients in the healthcare, energy and financial services industries. Across a range of advisory, consulting, outsourcing, and technology/analytics services, Navigant's practitioners bring sharp insight that pinpoints opportunities and delivers powerful results. More information about Navigant can be found at navigant.com.Navigant Cymetrix unites the strengths of four category-leading companies to address the complexities of today's healthcare system. We design, develop and implement integrated, patient-centered solutions for sustained improvements in performance and profitability, working collaboratively across a spectrum of customers that encompasses hospitals, health systems, physician practice groups and payers.The Registered Nurse will be directly responsible for reviewing denials & auditing client facility Medical Records (MR's) for a variety of facility required reviews including but not limited to documentation integrity reviews, lost charge audits &/or denial appeals. This position will perform all related job duties as assigned. **This is a remote** **position.**+ Review Medical Records+ Construct Warranted Appeals+ Ensure documentation and charge integrity+ Utilize e-Web coding and clinical guideline+ Conduct comprehensive Denial Root-cause analysis.+ Retrospective Medical Record reviews to assure complete and accurate physician/staff documentation is present for compliant coding reporting, lost charge audits, denial appeals &/or documentation integrity issues as per assignment detail-- including rationale for the initiation, discontinuation or adjustment of each treatment modality utilized in the care of the patient, lost charge identification &/or validity of Medical Necessity.+ Utilize Evidence -based clinical guideline tool (Milliman or InterQual )+ Research and application of regulatory policies to support clinical appeal.+ Telephonic communication with payors or facility staff as necessary for account denial resolution.+ Maintain current knowledge of basic Coding Clinic Guidelines.+ Ability to compile working spreadsheet &/or written presentation for client facility or internal partners.+ May be required to present oral presentations to client facility or Navigant BPM staff.+ Current Registered Nurse licensure+ Minimum of 5 years clinical experience.+ Utilization Review experience preferred.+ Attention to detail, strong organizational skills and self-motivated.+ Ability to independently & accurately make decisions and assimilate multiple data sources or issues related to problem solving.+ Ability to work under a timeline/deadline & provide clear & accurate updates to project leader of assignment progress, hours worked & expected outcomes daily.+ Familiarity with medical records assembly & clinical terminology, coding terminology additionally beneficial.+ Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.+ Deadline oriented assignments, heavy workload at times.+ Work Remotely.+ Up to 90% time spent working on computer & with Medical Records.+ Up to 5% time communicating with client staff and/or Navigant staff.+ Up to 5% time creating final working presentation of data collected in review.+ Occasional client or Navigant presentation required.+ Strong conceptual, as well as quantitative and qualitative analytical skills+ Work as a member of a team as well as be a self-motivator with ability to work independently+ Constantly operates a computer and other office equipment to coordinate work+ Frequently travels by airplane, train or car as necessary to perform work at another location+ Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data+ Generally works in an office environment**Navigant** **Cymetrix** is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information or any other basis protected by law, ordinance, or regulation.Navigant will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
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