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 Apply tot his job Apply To this Job