• Specialist-Denial II

    Location US-TN-MEMPHIS
    Posted Date 4 months ago(1/28/2019 2:21 PM)
    Position Code
    3484
    Status
    PRN
    Department
    HS Denial Mitigation
  • Overview and Responsibilities

    Department: HS DENIAL MITIGATION
    Job Summary: Reviews clinical information and supporting documentation for acute care inpatient Part A services to determine appeal
    action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned.

    Qualifications

    SPECIFICATIONS


    Experience
    Experience
    One or more of the following: - RN with 5 years experience
    in healthcare acute care hospital setting and one of the
    following - 3-5 years payer environment performing
    activities such as auditing, patient billing, and/or denial
    management. - 3-5 years Case Management experience

     

    Minimum Required
    RN, 5 years clinical experience in a clinical
    care setting.

     

    Preferred Experience

    Five years clinical experience and 3-5 years
    case management or denial management
    experience.



    Education


    RN Required

     

    Ability to type and/or key accurately and
    have strong organizational skills.


    Training


    Nursing, Case Management or Denial Management
    Familiarity with electronic medical records and
    claims/practice management systems.
    Requires critical thinking and judgement
    and must demostrates the ability to
    appropriately use standard criteria
    established by payers.


    Special Skills
    Excellent interpersonal, communication, and writing skills.
    Advanced computer literacy skills. Strong analytical and
    problem solving skills with an ability to understand and
    troubleshoot interconnected data and denial processes.
    Excellent communication skills. Advanced
    computer literacy skills with the ability to
    type and key accurately.


    Licensure Required
    RN

     

    Preferred

     

    CCM, CCS, RN



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