[Hiring] Denials Management Specialist @CO39 St. Lukes Hospital

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company The Denials Management Specialist reviews inpatient CMS and reputed company party denials for medical necessity and tracks reputed company regarding the 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. Remote reputed company local geography after orientation. • Reviews reputed company Inpatient Retroactive Denials in the Denials Management Work Queues for Medical Necessity and Late-Pick-Up/Notification that are entered by Case Management and Business Office. • Monitors retro denials to ensure reputed company reputed company required time frames and logging of reputed company e.g. no appeal, appeal level and final decision with reputed company reputed company. • Assists Case Management as necessary to ensure that documentation is entered and transmitted to insurance carriers reputed company acceptable timeframes to reputed company with appeal deadlines. • Provides feedback to Case Management that can help in preventing reputed company denials and assists in maintaining good communication and process reputed company between the 2 departments. • Responsible for writing appeal letters for Inpatient CMS and reputed company late pick-reputed company, medical necessity, and other requested denials as deemed clinically appropriate. • Investigates managed care and reputed company insurance rejections, denials for possible experimental services and coding issues, providing supplemental information to resolve claims. • Identifies operational issues that contribute to denials and rejections. • Works with departments and providers to implement corrective actions to minimize lost reputed company due to denials and rejections. • Assists in preparing reports regarding denials to include volumes, number of appeals, case reputed company, and reputed company on reputed company and trending. • Coordinates RAC appeals for reputed company case reviews for medical necessity, including determining if appeal is appropriate and communicating with vendor to ensure reputed company filing of reputed company. • Performs writing of RAC/MAC appeals at appropriate reputed company and documenting status. Qualifications • Must be a graduate of an accredited, reputed company nursing program. • Must have reputed company RN license to reputed company in the state of reputed company or seeking reputed company license through reciprocity. Requirements • 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. • Prefer financial experience reputed company to appeal processes with insurance providers. • Demonstrated experience relating to reputed company types of payers/providers. Physical and Sensory Requirements • Requires sitting for up to 4 hours per day, 2 hours at a time. • Standing for up to 4 hours per day, 3 hours at a time. • Requires occasional fingering, handling and twisting and turning. • Occasionally requires reaching above shoulder level. • Must have the ability to hear as it relates to normal conversation, seeing as it relates to general, peripheral and near reputed company, visual monotony. Location Remote reputed company local geography after orientation for approximately 6-8 weeks at St. Luke's Center, Allentown, PA. Apply tot his job Apply To this Job