Service Writer coordinating Service Department operations and communication between customers and technicians at Belkorp Ag. Managing work orders and ensuring service efficiency and professionalism.
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Hybrid Denials Management Specialist, Registered Nurse (RN) License Required
Posted 6 months ago
About the role
- Denials Management Specialist reviewing inpatient CMS and third party denials for medical necessity. Assisting billing staff and writing appeal letters in a committed healthcare environment.
Responsibilities
- Reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process.
- Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record review.
- Provides billing with information needed to obtain payment of claims.
- Monitors retro denials to ensure resolution within required time frames and logging of action e.g. no appeal, appeal level and final decision with revenue impact.
- Provides feedback to Case Management that can help in preventing future denials and assists in maintaining good communication and process flow between the 2 departments.
- Responsible for writing appeal letters for Inpatient CMS and Commercial late pick-ups, medical necessity, and other requested denials as deemed clinically appropriate.
- Investigates managed care and commercial insurance rejections, denials for possible experimental services and coding issues, providing supplemental information to resolve claim.
- Identifies operational issues that contribute to denials and rejections.
- Works with departments and providers to implement corrective actions to minimize lost revenue due to denials and rejections.
- Assists in preparing reports regarding denials to include volumes, number of appeals, case resolution, and impact on revenue and trending.
Requirements
- Registered nurse with current license to practice in the state of Pennsylvania or seek Pennsylvania licensure through reciprocity.
- Graduate of an accredited professional nursing program.
- Minimum of 2-5 years of clinical nursing experience in an acute care hospital setting required.
- Prefer minimum of 2-5 years’ experience in case management and/or utilization management required.
- Prefer financial experience related to appeal processes with insurance providers.
- Demonstrated experience relating to all types of payers/providers.
Benefits
- St. Luke's is proud of the skills, experience and compassion of its employees.
- The employees of St. Luke's are our most valuable asset!
- Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
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