Residence Requirements:

RESIDENCE REQUIREMENTS: THERE ARE NO RESIDENCY REQUIREMENTS FOR PARTICIPATION IN THIS EXAMINATION. There is one anticipated vacancy at the Erie County Medical Center Corporation.

Examples of Duties:

A Denial Management Nurse performs professional nursing duties in the coordination of denials management at the Erie County Medical Center Corporation; 

Coordinates the appeal process for third party payer denials;

Collaborates with other departments to identify and resolve reimbursement issues;

Completes charge verification for cost outliers and forwards to third party payers to realize full reimbursement for disputed charges;

Completes retrospective pre-certification as needed;

Provides feedback to involved parties to prevent further reimbursement issues;

Collaborates with Corporate Compliance staff to coordinate Recovery Audit Contractor (RAC) medical necessity denial activity;

Develops reports to identify reimbursement patterns/trends, provides insights regarding patterns/trends and distributes reports to involved departments as needed;

Maintains denial databases;

Completes reimbursement requests for excluded procedure/service for submission to Medicare/ Medicaid including Alternate level of Care applications;

Coordinates completion of quality concern responses;

Identifies documentation deficiencies and facilitates correction;

Educates facility staff on prevention denials of payment including admission and continued stay criteria, contractual requirements of various third party payers, necessary components to formulate a successful appeal letter and physician-to-physician review process;

Assists with utilization review process as needed;

Gathers data for evaluation of utilization of resources;

Participates in departmental Performance Improvement activities, staff meetings and interdisciplinary term conferences.

Qualifications:

MINIMUM QUALIFICATIONS:  Candidates must meet one of the following requirements on or before the date of the written test: 

A) Graduation from a regionally accredited or New York State registered college or university with a Bachelor’s Degree in Nursing and three (3) years of professional registered nursing experience in a medical/surgical or behavioral health setting and three (3) years of utilization review experience; or:

B) Graduation from a regionally accredited or New York State registered college or university with an Associate’s Degree in Nursing and five (5) years of professional registered nursing experience in a medical/surgical or behavioral health setting and three (3) years of utilization review experience; or:

C) Graduation from a regionally accredited or New York State registered School of Professional Nursing and seven (7) years of professional registered nursing experience in a medical/surgical or behavioral health setting and three (3) years of utilization review experience.

SPECIAL REQUIREMENTS:
Possession of a license and current registration to practice as a Professional Registered Nurse as issued by the New York State Department of Health at time of appointment; and:
Possession of a PRI (Patient Review Instrument) Certification before completion of probationary period.

Notes:

 1. Verifiable part-time and/or volunteer experience will be pro-rated toward meeting the experience requirements. 2. Your degree and/or college credit must have been awarded by a regionally accredited college or university or one recognized by the New York State Education Department as following acceptable educational practices. A grade of "D" or better is necessary for a course to be credited as successfully completed. If your degree and/or college credit was awarded by an educational institution outside of the United States and its territories, you must provide independent verification of equivalency. You can write to this Department for a list of acceptable companies providing this service; you must pay the required evaluation fee.

Notice to Candidates: Transcripts will now be accepted by the Department of Personnel ONLY at time of application. All subsequent transcripts must be submitted at time of interview.

The New York State Department of Civil Service has not prepared a test guide for this examination. However,candidates may find information in the publication "How to take a written test" helpful in preparing for this test. This publication is available on line at: www.cs.ny.gov/testing/localtestguides.cfm

Subjects of Examination:

SUBJECTS OF EXAMINATION: A written test designed to evaluate knowledge, skills and /or abilities in the following areas:

1. Evaluating health care

These questions test for knowledge of medical symptoms, diagnoses, treatments, and federal and New York State quality assurance standards and discharge planning; for the ability to apply this knowledge to given situations; and for the ability to evaluate client care and treatment.

2. Medical, psychiatric, developmental conditions and treatments

These questions will test for knowledge in areas such as: acceptable treatments and standard medical alternatives; symptoms, tests, procedures, and treatments associated with specific diagnoses; evaluation of the appropriateness of treatment methods; characteristics of the various populations diagnosed with mental illness or intellectual/developmental disabilities.

3. Preparing written material

These questions test for the ability to present information clearly and accurately, and to organize paragraphs logically and comprehensibly. For some questions, you will be given information in two or three sentences followed by four restatements of the information. You must then choose the best version. For other questions, you will be given paragraphs with their sentences out of order. You must then choose, from four suggestions, the best order for the sentences.

4. Understanding and interpreting health records and reports

These questions test for the ability to read, interpret, and apply information used in evaluating health care. You will be required to read and interpret selections from medical records and reports; laws, rules, and regulations relating to health care; and/or narratives on health-related topics.

NOTICE TO CANDIDATES: Unless otherwise noted, candidates are permitted to use quiet, hand held, solar or battery powered calculators. Devices with typewriter keyboards, "Spell Checkers", “Personal Digital Assistants", "Address Books", "Language Translators", "Dictionaries", or any similar devices are prohibited. You may not bring books or other reference materials.

**IMPORTANT APPLICATION FEE - READ CAREFULLY**

A $20.00 filing fee is required for this exam. The required fee must accompany your application. Send or bring check or money order made payable to Erie County Personnel Department and write the examination number(s) on your check or money order. Do not send or bring cash, as the County cannot be responsible for cash payment. As no refund will be made, you are urged to compare your qualifications carefully with the requirements for admission and file only for those examinations for which you are clearly qualified.