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Nurse Specialist II, Clinical Denials
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
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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