Henry Ford Health System
RN Coordinator- Payor Audit/Full Time/Remote
This job is now closed
Job Description
- Req#: 101261
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive salary based on experience
- Supportive and collaborative work environment
- Chance to make a positive impact on claim management and patient care
- Work within a centralized department focused on denial management strategies
What to Expect (Job Responsibilities):
- Review and prepare appeal letters for denied and rejected claims from various payers
- Utilize clinical judgment to assess medical necessity and coding-related denials
- Provide education and support for denial management strategies to key customers
- Serve as a liaison to hospital ancillary departments, physicians, payers, and auditors
- Analyze and apply appropriate medical necessity criteria to improve appeal success
What is Required (Qualifications):
- Minimum of three to five (3-5) years of clinical experience required
- Bachelor of Science in Nursing required, or three (3) years of Denial/Appeal/Utilization Management experience
- Knowledge of hospital billing and payer regulations
- Familiarity with criteria for patient status determination
- Valid, unrestricted Registered Nurse license from the State of Michigan required
How to Stand Out (Preferred Qualifications):
- Experience in denial management or utilization review within a healthcare setting
- Proficiency with tools and software used for billing and claim determination
- Strong analytical and problem-solving skills
- Excellent communication and interpersonal skills
- Ability to work independently and collaboratively in a team environment
#HealthcareServices #NursingJobs #ClaimManagement #CareerOpportunity #CompetitivePay
"We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. 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
The Henry Ford Health System is a comprehensive, integrated, non-profit health care organization in Metro Detroit.
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