Content Writer creating digital content for clients in online marketing agency. Engaging role involving text creation, SEO optimization, and communication concept development.
SN
Hybrid Denials Management Specialist, Registered Nurse (RN) License Required
Posted 4 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.
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Junior Content Writer responsible for producing high - quality content for AI solutions. Collaborating with marketing and product teams to create engaging narratives and strategies.
Nabisco Merchandiser/Order Writer joining Mondelēz team to fulfill merchandising needs through relationship building. Stocking shelves and optimizing product visibility for famous brands.
Nabisco Merchandiser/Order Writer managing merchandising needs for Mondelēz's iconic snack brands. Responsible for stocking shelves, promotional displays, and in - store communications.
Full Time Nabisco Merchandiser/Order Writer for Mondelēz responsible for stocking and maintaining displays. Join a team enhancing visibility of iconic brands like Oreo and Ritz.
Join Mondelēz as a Nabisco Merchandiser/Order Writer to fulfill merchandising needs of customers. Stock shelves, maintain displays, and build relationships with in - store employees in Oklahoma.
Senior Bid Writer responsible for leading high - quality bid responses at Amey. Collaborating with teams to create compelling proposals across multiple sectors with a strong focus on highways and rail.
Senior Bid Writer developing high scoring tender responses for the Infrastructure segment of BAM UK. Collaborating with teams to organize workshops and produce quality bid content.
Senior Bid Writer responsible for developing high scoring tender responses at BAM's UK Infrastructure segment. Engaging in collaborative bid processes and workshops across multiple locations.
Administrative Procedure Writer creating and updating administrative procedures for Savannah River Mission Completion. Responsible for maintaining accuracy and compliance in procedures on the Savannah River Site.