• Excellent writing skills.
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Knowledge of accreditation standards and compliance requirements.
• Knowledge of government and non-government payer practices, regulations, standards and reimbursement processes.
• Knowledge of established national medical necessity guidelines (InterQual(r) level of care LTAC criteria, Milliman Care Guidelines(r) for LTAC).
• Compose appeal letters for the Hospital Division, including Inpatient Rehabilitation Facilities (IRFs).
• Ability to review medical, financial and admission criteria documentation to prepare well-written appeal letters.
• Ability to communicate whether denial is substantiated or viable after review of medical, financial, and admission documentation.
• Regularly review periodicals, web sites and other media for changes in current guidelines.
• Provide educational material relative to types of claims and errors identified during review of medical and financial documentation.
• Recommend projects that promote documentation improvement (i.e. form, ProTouch, other documentation standardization/ compliance projects) reducing risk of denied claims.

• Working knowledge of healthcare law.
• Strong written and verbal communication skills.
• Ability to work with individuals at all levels of the organization.
• Knowledge of long-term acute care industry.
• Knowledge of state and federal regulations.
• Proficient computer skills.

Education:

• Bachelor's degree in clinical field required

• Registered Nurse preferred

• 3+ years experience in clinical setting required
• 1+ years experience in hospital case management required