Community Healthcare System is hiring a Denials Resolution Specialist

Under the direction of the Director of Utilization / Case Management / Social Service, the Denials Resolution Specialist reviews, appeals, advises, and collaborates with the medical staff in the resolution of treatment and services denied by Medicare, Medicaid, Tricare, commercial payers, and Managed Care organizations throughout the Community Healthcare System

Roles and Responsibilities :

• Reviews the medical record and the Utilization / Case Management reports by utilizing InterQual criteria for severity of illness and intensity of service.
• Advises, assists and acts as a resource person for the Medical Staff.
• Coordinates, correspondence with physicians and the review appeal agencies.

Required Skills & Qualifications :

• Registered Nurse with a Bachelor’s degree in nursing preferred. Relevant professional certification (certified coder, etc.) highly desirable.

Your Extraordinary Career Starts Here

We invite you to join our team of professionals where your unique talents will be well utilized in a work environment that promotes your further growth and development.

In return for your valuable service and contributions, CHS offers a competitive wage and benefits package along with the necessary tools, resources and mentoring opportunities to support your career advancement goals.

Our comprehensive benefits program includes, but is not limited to :

• Medical, dental and vision coverage
• Wellness program, including free screenings
• Healthcare and Dependent Care Spending Accounts (HSA)
• Retirement savings plan
• Life insurance
• Disability income protection
• Employee Assistance Program (EAP)
• Fitness center discount program
• Tuition assistance and career development
• Paid Time Off (PTO)
• Reward and recognition programs

Join our team of healthcare professionals at Community Healthcare Systems. Apply today!

Last updated : 2024-05-10