RN Denial Management Specialist
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Job Description
RN Denial Management Specialist managing clinical audits and denial processes at Banner Health. Requires significant nursing experience and offers remote work in selected US states.
Responsibilities:
- Provides clinical expertise and oversight in the determination of the clinical appeals and denial management process resulting in significant savings for the organization.
- Evaluates and intervenes retrospectively for coverage issues, payor outliers, split billing, disallowed charges, incorrect DRG codes, denial and compliance issues.
- Quantifies, analyzes, and monitors industry/Medicare trends in order to reduce denials and improve the financial outcomes for the organization.
- Serves as a resource and provides leadership assistance to achieve optimal clinical, operational, financial, and satisfaction outcomes across the system as related to federal, state and commercial reimbursements.
- Supports change and participates in the development, implementation and evaluation of the goals/objectives and process improvement activities across the organization as related to federal, state and commercial reimbursements.
Requirements:
- Requires Registered Nurse (R.N.) licensure in the state of practice.
- Requires experience in federal, state and commercial reimbursements and in reviewing clinical information typically acquired in three years auditing DRG coding and reimbursements.
- Requires five or more years of clinical nursing and/or related experience.
- Experience in evaluation techniques, teaching, hospital operations, reimbursement methods, medical staff relations, and the charging/billing process is required.
- A working knowledge of utilization management and patient services is required.
- A working knowledge of Medical and third party payor requirements and reimbursement methodologies is required.
- Highly developed human relation and communication skills are required.
- Must demonstrate critical thinking, problem-solving, effective communication, and time management skills.
- Must demonstrate ability to work independently as well as effectively with team members.
- Must be proficient in the use of office desktop software programs.
Benefits:
- Health insurance
- retirement plans
- paid time off
- flexible work arrangements
- professional development
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