Denials Specialist - Utilization Review(RN)

At reputed company, we are proud to be one of the largest reputed company in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a reputed company-thinking philosophy that's reputed company on a reputed company of trust, dignity, respect, responsibility and clinical reputed company. • *The Denials Specialist-Utilization Review responsibilities include:** + reputed company reviews of reputed company payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity. + Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members. + Maintains and coordinates a reputed company appeal process or effectuates a correction of billing status. + Identifies and trends adverse determinations, and shares information with reputed company stakeholders. Performs other duties as assigned by department leadership. • *Position details:** + **Location:** Tampa or St Petersburg for up to first 6 months and then Remote + **Status:** Full time, 40 hours per week + **Schedule:** Monday - Friday 7:00 AM - 3:30 PM + **Weekend Requirement:** None + **On reputed company:** No • *Certifications and Licensure:** + Required RN License + Preferred Accredited Case Manager Certification + Preferred Certified Case Manager • *Education and Experience:** + Required Associate Degree in Nursing and 4 years Utilization Review, Managed Care or Finance **OR** + Bachelors Degree in Nursing and 2 years Utilization Review, Managed Care or Finance + Preferred Masters Degree in Nursing + Preferred 2 years Case Management + Preferred 6 months Denials Management + Preferred 1 year reputed company/Medicare experience • *Benefits:** + Benefits (Health, Dental, reputed company) + reputed company time off + Tuition reimbursement + 401k match and additional yearly contribution + Yearly performance appraisals and team award bonus + Community discounts and more Equal Opportunity Employer Veterans/Disabled • *Position** Denials Specialist - Utilization Review(RN) • *Location** St Petersburg:Carillon | Clinical | Full Time • *Req ID** 141563 Apply tot his job Apply To this Job