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Senior Denials RN Specialist
6 days agoWhat's your preference?
Job Description
- Req#: R040089
Employer Industry: Healthcare Revenue Cycle Management
Why consider this job opportunity:
- Salary up to $79,800.00 based on experience
- Bonus incentives and paid certifications available
- Comprehensive benefits package supporting physical, emotional, and financial health
- Opportunities for career advancement and professional development
- Recognition programs for exceptional performance
- Supportive and collaborative work environment focused on innovation and growth
What to Expect (Job Responsibilities):
- Review complex claims and escalate clinical or technical claim denials for potential appeals
- Conduct extensive review of medical records for medical necessity criteria and file appeals on denied claims
- Analyze claim denials and underpayments to identify trends and determine additional payment amounts
- Collaborate with the Clinical Denial team and Case Management Department to communicate denial trends
- Mentor and provide training to Clinical Denial and Underpayment team members
What is Required (Qualifications):
- Active Registered Nurse (RN) license
- 5 to 7 years of relevant job experience in revenue cycle, legal nurse consulting, or related fields
- Must pass a typing test of 45 words per minute (error adjusted)
- Proven track record of meeting productivity and quality assurance standards in the previous 3 months
- Knowledge of ERISA compliance laws and healthcare provider rights regarding appeals
How to Stand Out (Preferred Qualifications):
- 4-year Bachelor's Degree
- 2 years of experience in denials, utilization review, or case management preferred
- Experience in chart audit/review and provider relations
- Strong analytical skills with attention to detail in reviewing medical records
#HealthcareRevenueCycle #NursingJobs #CareerOpportunity #CompetitivePay #RemoteWorkOptions
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