What are the responsibilities and job description for the RN Clinical Denial Recover Analyst | Enterprise Denials | Full Time | Day Shift position at UF Health?
Overview
The clinical denial management nurse is responsible for completing, tracking, and reporting clinical denials at an enterprise level between all UF hospitals. Reporting to Enterprise Denial Nurse Manager, this role serves as a support to revenue cycle including clinical departments, finance, accounting, compliance, patient financial services, revenue integrity, managed care, utilization review, and patient access.The clinical denial management nurse is considered a clinical expert in denial management and ensures all denied claims are accurately worked from a clinical perspective, and appropriately appealed to secure maximum reimbursement and minimize organizational write-offs.
Responsibilities
Necessary Skills
Job Opening Qualifications
Education
Required:
Required:
Required:
The clinical denial management nurse is responsible for completing, tracking, and reporting clinical denials at an enterprise level between all UF hospitals. Reporting to Enterprise Denial Nurse Manager, this role serves as a support to revenue cycle including clinical departments, finance, accounting, compliance, patient financial services, revenue integrity, managed care, utilization review, and patient access.The clinical denial management nurse is considered a clinical expert in denial management and ensures all denied claims are accurately worked from a clinical perspective, and appropriately appealed to secure maximum reimbursement and minimize organizational write-offs.
Responsibilities
Necessary Skills
- Demonstrated knowledge of hospital billing and reimbursement, Medicare and Medicaid denials and appeals, third-party contracts, and federal and state healthcare regulations
- Strong critical thinking and analytical skills
- High attention to detail with the ability to work independently and produce work with minimal errors
- Excellent organizational and time-management skills with the ability to prioritize workload
- Strong written and verbal communication skills
- Proficiency in Microsoft Office applications, including Outlook, Word, and Excel
- Knowledge of HIPAA guidelines
- Ability to read and interpret Explanation of Benefits (EOBs)
- Strong research and problem-solving skills
- High level of comfort with computer systems and technology
Job Opening Qualifications
Education
Required:
- High School Diploma or GED
- Bachelor’s Degree in Nursing (BSN)
Required:
- Licensed to practice Registered Nursing (RN) or Practical Nursing (LPN) in the State of Florida
- CPC, COC, RHIT, RHIA, or CCS
Required:
- 2–3 years of clinical experience as a Registered Nurse (RN) OR
- 3–5 years of clinical experience as a Licensed Practical Nurse (LPN)
- Knowledge of or experience in coding, medical record review, auditing, and/or insurance