Baptist Health South Florida
Denial & Appeals Coordinator, RN, Concurrent Denials Prevention, FT, 08:30A-5P
This job is now closed
Job Description
- Req#: 152290
Employer Industry: Healthcare Services
Why Consider this Job Opportunity:
- Salary range up to $114,999.25 per year, depending on experience
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment with a focus on compassion and quality care
- Chance to make a positive impact on patient care and outcomes
- Work with a renowned healthcare organization recognized as one of Fortune’s 100 Best Companies to Work For
What to Expect (Job Responsibilities):
- Act as a senior expert consultant for Case Management to ensure high-quality patient care and efficient resource utilization
- Evaluate denials and non-certified days from third-party payors to assess the appropriateness of appeals
- Collaborate with attending physicians and case managers to formulate secondary and formal appeals using medical management tools
- Serve as an internal consultant for multiple departments regarding regulatory and billing requirements
- Review all surgery cases to ensure appropriate coding, authorization, and medical necessity prior to billing
What is Required (Qualifications):
- Bachelor’s degree
- Current Registered Nurse license and one of the listed certifications (e.g., CCMC Case Manager)
- Minimum of 2 years of experience in hospital or payor Utilization Management review
- Strong written and interpersonal communication skills
- Minimum of 3 years of hospital clinical experience preferred
How to Stand Out (Preferred Qualifications):
- MCG Certification or eligibility to pursue within 90 days of hire
- Experience in case management and utilization review/surgery pre-anesthesia
- Familiarity with CPT, ICD-9 & -10, and DRG coding
- Current working knowledge of payor and managed care reimbursement
- Ability to research evidence-based practices
#HealthcareServices #CaseManagement #PatientCare #CareerOpportunity #CompetitivePayAbout 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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