Remote Jobs
Denials Specialist - Utilization Review(RN)
This job is now closed
Job Description
- Req#: 141563
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely after the initial 6-month period
- Comprehensive benefits package including Health, Dental, and Vision
- Tuition reimbursement for continued education
- 401k match with additional yearly contributions
- Yearly performance appraisals and team award bonuses
What to Expect (Job Responsibilities):
- Conduct timely reviews of all payor, inpatient and outpatient claims that have been denied or may not meet medical necessity
- Collaborate closely with Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit (CAU), and Coding department team members
- Maintain and coordinate a timely appeal process or effectuate corrections to billing status
- Identify and trend adverse determinations, sharing information with all stakeholders
- Perform other duties as assigned by department leadership
What is Required (Qualifications):
- Required RN License
- Required Associate Degree in Nursing and 4 years of Utilization Review, Managed Care, or Finance, or a Bachelor's Degree in Nursing with 2 years of Utilization Review, Managed Care, or Finance
- Preferred Master's Degree in Nursing
- Preferred 2 years of Case Management experience
- Preferred 6 months of Denials Management experience
How to Stand Out (Preferred Qualifications):
- Preferred Accredited Case Manager Certification
- Preferred Certified Case Manager
- Preferred 1 year of Medicaid/Medicare experience
#HealthcareServices #UtilizationReview #CareerOpportunity #RemoteWork #EmployeeBenefits
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