This is a US based remote position.
Overview
Myriad Genetics, Inc. is in search of an outstanding candidate, with insurance utilization management experience, to work as a Nurse Advocate on a group of products that represent pioneering advances in the field of molecular diagnostics. Continued growth and expansion of our portfolio has necessitated this new position that is responsible for leading and performing individual work on appeals for erroneous denials and obtaining patient chart notes. This position joins an elite team building a culture of revenue cycle excellence and continuous improvement and will influence the entire department to deliver material revenue and profit to the company. The Nurse Advocate reports to the Director of Prior Authorizations and will serve as a key thought partner for the Vice President and Managers, as well as Payor Markets and Customer Service leaders throughout the company.
Responsibilities
- Understand Myriad products and their recommended use in patient populations.
- Understand the details required to document for a payor how a patient is appropriate for coverage for the test their doctor ordered.
- Understand insurance denial reasons on claims and prior authorizations, and insurance appeal processes for claims and prior authorizations.
- Be a strong advocate for patients to challenge erroneous denials and obtain medical records from clinician offices.
- Be skilled at communication during situations that can be tense and complex to prioritize appropriate patient coverage for testing ordered by their clinician.
- Prepares and provides training for the Revenue Cycle team on how to replicate processes designed by the Nurse Advocate to challenge erroneous insurance denials and obtain medical records from clinician offices.
- Speak to patients, when needed, to explain and understand their individual situation and how Myriad can work with them to obtain coverage for appropriate testing.
- Assist Revenue Cycle leaders with measuring predictors of success in gaining coverage and identify root causes for denials. Coordinate payor reviews with Revenue Cycle and leaders to meet company goals to reduce unpaid tests.
- Develops relationships with Revenue Cycle vendors to ensure vendor performance and quality meets or exceeds standards set for those relationships.
- Drives a culture of continuous improvement that engages the Revenue Cycle Management team and participates in the Quality Assurance plan.
Qualifications
- RN is required.
- 5+ years of related experience with 3+ years as a nurse reviewer at a payor required.
- Demonstrated ability to interact with clinician offices and clinicians to overcome barriers to appropriate patient care.
- Intermediate knowledge of Microsoft Word and Excel.
- Working knowledge of ICD-10, CPT and HCPCS coding, HIPAA regulations, and insurance appeal procedures.
Physical Requirements
Lifting Requirements – light work or exerting up to 20 pounds of force frequently. Physical Requirements – stationary positioning, moving, operating, ascending/descending, communicating, observing, pushing or pulling, and reaching. Use of equipment and tools necessary to perform essential job functions.
EEO
We recognize that our people are our strength and the diverse talents they bring to our global workforce are directly linked to our success. We are an equal opportunity employer and place a high value on diversity and inclusion at our company. In hiring and all other employment decisions, we prohibit discrimination and harassment on the basis of any protected characteristic, including race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, marital or veteran status, pregnancy or disability, or any other basis protected under applicable law. In accordance with applicable law, we make reasonable accommodations for applicants’ and employees’ religious practices and beliefs, as well as any mental health or physical disability needs.
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