RN Denial Management Specialist

🔥 0 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $37 - $61 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Banner Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Banner Health is a leading healthcare system committed to making healthcare easier through comprehensive patient services and resources. They provide a safe place for care with services ranging from emergency and urgent care, imaging, and surgery centers to maternity and hospice care. Banner Health also offers telehealth options to ensure access to healthcare, regardless of location. They support athletes through Banner Orthopedics & Sports Medicine and have been recognized for exceptional patient care. With advanced digital tools, they aim to manage healthcare seamlessly for their patients.

📋 Description

• Support the organization’s Recovery Audit Contractor (RAC) program by reviewing clinical information and auditing billings for appropriateness under CMS standards • Provide oversight for the retrospective denial management process • Determine clinical appeals and manage denials to secure reimbursement and generate organizational savings • Respond to audit requests by reviewing charts and preparing appeals • Authorize appropriate write-offs for claims that do not meet hospitalization criteria • Educate staff and physicians on regulatory compliance measures and clinical system criteria • Evaluate and intervene on coverage issues, payer outliers, split billing, disallowed charges, incorrect DRG codes, denial, and compliance issues • Quantify, analyze, and monitor industry and Medicare trends to reduce denials and improve financial outcomes • Recommend process improvements based on denial and reimbursement trends • Provide leadership assistance and consult facilities regarding federal, state, commercial reimbursements, and DRG code use • Participate in development, implementation, and evaluation of organizational reimbursement goals and process improvement activities • Interact internally with physicians, clinicians, and management; interact externally with RAC auditors and other organizations

🎯 Requirements

• Minimum of 5 years of clinical nursing experience • Experience in federal, state, and commercial reimbursements and reviewing clinical information, typically acquired in three years auditing DRG coding and reimbursements • Active Registered Nurse (R.N.) licensure in the state of practice • Experience in evaluation techniques, teaching, hospital operations, reimbursement methods, medical staff relations, and charging/billing processes • Working knowledge of utilization management and patient services • Working knowledge of Medicare and third-party payer requirements and reimbursement methodologies • Critical thinking, problem-solving, effective communication, and time management skills • Ability to work independently and effectively with team members • Proficiency in office desktop software programs • Ability to meet daily and weekly productivity metrics • Moderate to strong technology skills • Must live in one of the specified states: AK, AL, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, or WY • Must work at least 75% of the shift within 7AM to 5PM AZT/MST • BSN preferred • Additional related education and/or experience preferred

🏖️ Benefits

• Health and financial security benefit plan options • No holidays or weekends • Monday-Friday, 8-hour shifts • Fully remote position