Claims Utilisation Nurse

Part Time NTPF  Claims and Utilisation Nurse

Job Purpose

This position will be to promote and preserve the Hospital mission, values (Human Dignity, Integrity, Compassion, Stewardship & Service) and ethos by effective delivery of mission objectives in your capacity as NTPF and Claims Utilisation Nurse.                           

Key Duties and Responsibilities:

• Promotes and preserves the Bon Secours Mission, Values & Ethos.
• Provides on-going completion of Consultant clinical documentation to ensure timely claim form submissions within agreed target guidelines.
• Completion of supporting consultant documentation to ensure billing is completed accurately and in line with consultant contract.
• Review part paid claims and completion of appeal letters where claim has not been paid in full.
• Develop relationships with consultants, hospital departments, including IT to identify potential improvement opportunities.
• Establish and maintain review meetings with Consultants or their supporting staff to discuss and improve KPIs, denial trending and any documentation issues.
• Communicates in a way that promotes trust and credibility between the revenue cycle functional teams and consultants and hospital leadership and strives to strengthen local and facility relationships for positive outcomes.
• Develop and maintain relationships with NTPF Co-ordinator, NTPF, referring hospitals liaison offices and Consultant medical staff and their secretaries. 
• Assist the NTPF coordinator with the interpretation of clinical referral data and advise the co-ordinator on the appropriate referral pathways.
• Assist the NTPF co-ordinator with the description and definition of outliers and provide advice on the clinical justification of same.
• In liaison with the BSHD Finance Department, assist the NTPF Co-ordinator and Administrative Team in the collation of NTPF discharge summaries and hospital accounts for submission to NTPF.
• Assist the NTPF co-ordinator and Administrative Team in patient bookings and the full and accurate completion of NTPF discharge summaries. 
• Following  up with consultants regarding outstanding discharge summaries and delayed discharge summaries generated for referring hospitals. 
• Escalates issues to direct leader as necessary to ensure timely resolution.

Essential Qualifications

• Leaving Certificate or equivalent
• RGN qualification

Desirable Qualifications

• Higher Diploma in business or related subject

Essential Experience

• 3-5 years general nursing experience

Desirable Experience

• 3-5 years’ experience in Hospital billing, Consultant billing, or Insurer claims processing.

Essential Skills

• Excellent communication skills with clear presentation and reporting ability
• Strong and demonstrated analytical and problem-solving abilities
• Demonstrated proficiency Microsoft Excel, and other Microsoft Office Suite applications.
• Service-oriented and proactive team player
• Ability to develop strong co-operative working relationships
• Able to motivate and challenge team members

For more information contact me at sonia.tzaferi@cplhealthcare.com