Nurse Specialist II, Clinical Denials

Job not on LinkedIn

🔥 15 hours ago

🏈 Alabama, Arizona, +17 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌪️ Kansas – Remote 🦞 Maine – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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Knowtion Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2008

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Private Equity Round on 2020-09

Consulting • Insurance • Logistics

Knowtion Health is a company that assists hospitals in handling denied and complex claims, recovering low balance accounts, and providing defense against payer audits. By leveraging advanced technology and a team of experts, Knowtion Health aims to maximize revenue and improve patient experiences. Their services include addressing clinical denials and managing various challenging payer classes, positioning them as a strong advocate for their clients in the healthcare sector.

📋 Description

• Review medical record documentation to verify medical necessity issues related to length of stay, level of care, readmissions, experimental/investigational services, and similar matters • Create detailed clinical analyses and appeal letters for payer denials to support payment of patient claims • Manage inventory and follow up on accounts as appropriate • Review InterQual/Milliman and/or payer medical policies related to denied procedures or services and include criteria in analyses and appeal letters as appropriate • Provide feedback to the supervisor regarding issues identified for ongoing training of peers and non-clinical staff • Identify root causes and trends to share with clients and staff • Work with attorneys and claims representatives to review and appeal claims when appropriate to overturn clinical denials from Medicare, Medicaid, and other third-party payers

🎯 Requirements

• Licensed RN required • At least 2 years of experience in an acute care hospital required • Three to five years of experience in utilization review, case management, quality assurance, discharge planning, or other cost management programs preferred • Experience using InterQual and Milliman healthcare criteria preferred • Experience reviewing CMS LCD/NCD criteria preferred • Proficient typing and computer skills essential • Valid government-issued photo ID required during screening and/or interviews • Applicants located in the following states are prioritized: Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Indiana, Kansas, Maine, Michigan, Missouri, Mississippi, North Carolina, New Mexico, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Wisconsin, West Virginia

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Life insurance • Short-term disability • Long-term disability • Bonus opportunities • Paid holidays • 401(k) • Generous PTO policy • Dedicated, distraction-free work space at home