Baptist Health South Florida
Denial & Appeals Coordinator, RN, Concurrent Denials Prevention, FT, 08:30A-5P
This job is now closed
Job Description
- Req#: 141072
Employer Industry: Healthcare Services
Why Consider this Job Opportunity:
- Salary up to $113,311.74/year
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits package
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and resource utilization
- Expert internal consultant role in multiple departments
What to Expect (Job Responsibilities):
- Serve as a senior expert consultant for Case Management
- Evaluate denials and non-certified days from 3rd party payors
- Formulate secondary appeals and written formal appeals for medical necessity determination
- Serve as liaison between hospital and regulatory bodies
- Review all surgery cases pre and post-procedure to ensure appropriate billing
What is Required (Qualifications):
- Bachelors degree
- RN license and one of the listed certifications
- 3 years of hospital clinical experience preferred
- 2 years of hospital or payor Utilization management review experience required
- Strong analytical, data management, and computer skills
How to Stand Out (Preferred Qualifications):
- Case management, utilization review, or surgery pre-anesthesia experience preferred
- Familiarity with CPT, ICD-9 and -10, and DRG coding
- Strong ability to research evidence-based practices
#HealthcareServices #CaseManagement #CareerOpportunity #CompetitivePay #RegulatoryCompliance
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Baptist Health South Florida is a faith-based, not-for-profit healthcare organization and clinical care network in southern Florida.
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