Specialist-Denial II RN – HS Denial Mitigation Corporate

Summary

Reviews clinical information and supporting documentation for acute care inpatient Part A services to determine appeal action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned.

Responsibilities

Reviews, assesses, and evaluates all communications received in order to optimize reimbursement.

Evaluates clinical information and supportive documentation prior to initial appeal action in order to optimize reimbursement and utilization of resources.

Prepares response to appeal/request for information based on supporting clinical information in order to enhance reimbursement and maximize customer satisfaction.

Compiles, analyzes, and distributes necessary clinical and financial information and presents reports to other healthcare providers in order to improve performances, and increase awareness of resources consumed related to reimbursement.

Completes assigned goals.

Requirements, Preferences and Experience

Education

Minimum: Ability to type and/or key accurately and have strong organizational skills.

Experience

Preferred: Five years clinical experience and 3-5 years case management or denial management experience.

Minimum: RN, 5 years clinical experience in a clinical care setting.

Licensure, Registration, Certification

Preferred: CCM;RN;CCS

Minimum: RN

Special Skills

Minimum: Excellent communication skills. Advanced computer literacy skills with the ability to type and key accurately.

Training

Minimum: Requires critical thinking and judgement and must demostrates the ability to appropriately use standard criteria established by payers.

About Baptist Memorial Health Care

At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christs three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.

At Baptist, We Offer:

Competitive salaries

Paid vacation/time off

Continuing education opportunities

Generous retirement plan

Health insurance, including dental and vision

Sick leave

Service awards

Free parking

Short-term disability

Life insurance

Health care and dependent care spending accounts

Education assistance/continuing education

Employee referral program

Job Summary:

Position: 3484 – Specialist-Denial II RN

Facility: BMHCC Corporate Office

Department: HS Denial Mitigation Corporate

Category: Finance and Accounting

Type: Non Clinical

Work Type: Full Time

Work Schedule: Days

Location: US:TN:Memphis

Located in the Memphis metro area REQNUMBER: 24986