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This position requires a current Licensed Practical Nurse (LPN) or Registered Nurse (RN) license.
Essential Duties and Responsibilities (List in order of importance or percentage of time spent on the particular responsibility – High to Low | |
1. | Maintains a working mastery of industry-standard utilization review criteria (i.e.: Interqual), coverage guidelines, and payor medical policies |
2. | Demonstrates knowledge of governmental, managed care, and commercial denial/appeal policies |
3. | Appropriately reviews and triages denials for A/R, billing, downgrade, appeal, or denial adjustment |
4. | Able to prioritize and manage caseload without jeopardizing timely filing |
5. | Demonstrates excellent technical and clinical skills by drafting credible, defensible appeals |
6. | Conducts thorough evidence-based clinical literature research to support appeals, as needed |
7. | Understands and files appropriate levels of appeal (i.e.: reconsideration, dispute, appeal, ALJ…) |
8. | Accurately enters data into the Appeal Tracker, Cerner/ClaimIQ/Artiva, or other programs |
9. | Notifies department leadership regarding patterns/trends |
10 | Together works with department leadership and other Denial Management Team Members to develop and facilitate processes which promote job effectiveness and efficiency |
12 | Ability to perform all other duties as assigned or requested |
13 | Ensure confidentiality of all patient accounts by following HIPAA guidelines |
Full Time
$75k-95k (estimate)
01/19/2024
05/03/2024