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Knowtion Health

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Nurse Specialist II, Clinical Denials

GeneralGeneralFull TimeRemoteMid LevelTeam 501-1,000Since 2008H1B SponsorCompany SiteLinkedIn

Location

Alabama + 18 moreAll locations: Alabama | Arizona | Florida | Idaho | Kansas | Maine | New Mexico | North Carolina | Oklahoma | Michigan | Mississippi | Missouri | Pennsylvania | South Carolina | Tennessee | Texas | Virginia | West Virginia | Wisconsin

Posted

19 hours ago

Salary

0

Seniority

Mid Level

Professional Certificate2 yrs expEnglish

Job Description

Nurse Specialist II, Clinical Denials

Knowtion Health

• Review medical record documentation to verify medical necessity issues as related to length of stay, level of care, readmissions, experimental/investigational, etc. • Create detailed clinical analyses and appeal letters for denials from payer to support payment of patient claims • Managing Inventory and Following up on accounts as appropriate • Review InterQual/Milliman and/or payer medical policies related to denied procedures or services and include criteria in analysis/appeal letter as appropriate • Provide feedback to supervisor regarding issues identified for ongoing training to peers and non-clinical staff members • Identify root cause and trending to share with clients and staff

Job Requirements

  • Licensed RN
  • At least 2 years experience in an acute care hospital required
  • Three to five years of experience in utilization review, case management, quality assurance, discharge planning or other cost management programs preferred
  • Experience using InterQual and Milliman healthcare criteria preferred
  • Experience reviewing CMS LCD/NCD criteria preferred
  • Proficient typing and computer skills essential

Benefits

  • medical
  • dental
  • vision
  • life insurance
  • short term disability
  • long term disability
  • bonus opportunities
  • paid holidays
  • 401k
  • generous PTO policy

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