Denial Prevention Nurse Consultant

🔥 15 hours ago

🏈 Alabama, Connecticut, +26 more states – Remote

🏈 Alabama – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🗻 New Hampshire – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Revecore

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

☁️ SaaS

🤝 B2B

Healthcare • SaaS • B2B

Revecore is a healthcare revenue recovery company that combines proprietary AI, claims intelligence, workflow automation, and clinical, legal, and reimbursement expertise to identify and recover missed revenue for hospitals and health systems. Their ReClaim™ platform and network intelligence use machine-learning models and payor rule engines trained on hundreds of millions of claims to automate decisioning, prioritize recoveries, manage complex claims (VA, auto accidents, workers' compensation, Medicaid), denials management, underpayment recovery, and accounts receivable acceleration. Revecore operates HIPAA-compliant, SOC 2-certified infrastructure and serves over 1,300 hospitals, emphasizing outcomes like increased reimbursement, faster reimbursement, and high denial overturn rates.

📋 Description

• Review medical records and medical documentation to determine appropriate billable services • Construct appeals for payment based on medical necessity or payer-specific guidelines and criteria • Provide clients with denial trending, revenue cycle fail-point analysis, and best-practice remediation recommendations • Build relationships with clients, payors, and Revecore personnel • Analyze medical records to validate services, tests, supplies, and drugs for billing accuracy • Identify and interpret medical, radiological, laboratory, and other tests and procedures, as well as pharmaceutical drugs • Review managed care contracts, hospital billing statements, and insurance denials • Research commercial and governmental payor policies, clinical abstracts, studies, and claim-payment documentation • Evaluate and appeal denied claims • Research denials and communicate information to associates, colleagues, managers, and clients • Contact insurance companies to obtain missing information and resolve underpayments or denials • Arrange payment or adjustment processing on behalf of clients • Prepare and submit letters, emails, online inquiries, appeals, adjustments, reports, and payment postings • Identify revenue-cycle and payer-side fail points and provide best-practice recommendations • Maintain contact with payors, clients, managers, and Revecore personnel regarding claim status • Maintain confidentiality in compliance with company policy and HIPAA • Attend client, department, and company meetings • Lead client meetings and provide consulting services regarding medical necessity and payer criteria

🎯 Requirements

• College degree or diploma from school of nursing — must be RN • Clinical nursing experience in a hospital environment, preferably in ER, Critical Care or diagnostic services • Minimum 5 years of related experience and/or training in utilization review or patient accounting • Highly proficient with InterQual and MCG guidelines • Understanding of patient accounting documents, including UB04 and EOB • Working knowledge of Microsoft Office (Word, Excel, Outlook) • Technical proficiency using multiple computer screens and software applications simultaneously • Ability to read and interpret medical records, patient care systems, instructions, policies and procedures in English and diagram form • Ability to maintain strong performance in a fast-paced environment with productivity metrics • Strong analytical, attention to detail, and problem-solving skills • Experience with healthcare billing software and databases, including EPIC, Cerner, and Meditech • Quiet, distraction-free home work environment • Secure internet connection • Home internet speeds greater than 20 Mbps download and 10 Mbps upload • Workspace must accommodate workstation equipment and related materials • Must reside in the United States within an approved state • Employment eligibility to work in the United States • Successful completion of employment history verification and background check

🏖️ Benefits

• Comprehensive training begins on the first day and lasts 90 business days • Ongoing support from teammates following training • Access to a robust knowledgebase • Individual performance metrics to enable goal setting • Computers and necessary work equipment provided • Involved management support • Remote work from home