RN Denial Management Specialist

🔥 0 minutes ago

🏈 Alabama, Arizona, +29 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $37 - $61 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Banner Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1999

⚕️ Healthcare Insurance

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

• 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