Nurse Specialist II, Clinical Denials

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🏈 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

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Knowtion Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2008

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

💰 Private Equity Round on 2020-09

Healthcare Insurance • Fintech • SaaS

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 as related to length of stay, level of care, readmissions, experimental/investigational, etc. • Create detailed clinical analyses and appeal letters for denials from payer to support payment of patient claims • Managing Inventory and Following up on accounts as appropriate • Review InterQual/Milliman and/or payer medical policies related to denied procedures or services and include criteria in analysis/appeal letter as appropriate • Provide feedback to supervisor regarding issues identified for ongoing training to peers and non-clinical staff members • Identify root cause and trending to share with clients and staff

🎯 Requirements

• Licensed RN • At least 2 years 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

🏖️ Benefits

• medical • dental • vision • life insurance • short term disability • long term disability • bonus opportunities • paid holidays • 401k • generous PTO policy