Denials Specialist RN - Utilization Review

BayCare Health System; Tampa (FL); Híbrido; USD 70.000 - 110.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Dental insurance

Vision insurance

Paid time off

Tuition reimbursement

401k match

Annual bonus

Descripción de la vacante

BayCare Health System in Tampa, FL is seeking a Denials Specialist RN - Utilization Review to review payor and hospital denials, determine medical necessity, and coordinate timely appeals. This full-time, hybrid role collaborates with Physician Advisors, Registration, Central Business Office, Central Authorization Unit and Coding to resolve billing issues.

The position requires RN licensure (ASN with 4 years or BSN with 2 years), UR or care coordination experience, and preferred CCM/ACC M

Formación

• RN license required.
• 4 years RN experience with ASN; 2 years RN experience with BSN.
• 2 years Utilization Review or Care Coordination/Case Management/Managed Care/Finance experience.
• Masters degree preferred.

Responsabilidades

• Timely reviews of payor, inpatient and outpatient claims denied or not meeting medical necessity.
• Collaborate with Physician Advisors, Registration, CBO, CAU, and Coding department teams.
• Maintain and coordinate timely appeal processes or correct billing status.
• Identify and trend adverse determinations and share findings with stakeholders.
• Perform other duties as assigned by department leadership.

Conocimientos

Care coordination

Denials management

Collaboration

Clinical documentation

Educación

ASN degree

BSN degree

Masters preferred

Herramientas

Accredited Case Manager Certification

Certified Case Manager

Descripción del empleo

At BayCare, we are proud to be one of the largest employers 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 forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

The Denials Specialist-Utilization Review responsibilities include:

• Timely reviews of all 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 timely appeal process or effectuates a correction of billing status.

• Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.

Position details:

• Location: Hybrid - Tampa/St Petersburg

• Status: Full time, 40 hours per week. Exempt

• Schedule: Monday - Friday 7:00 AM - 3:30 PM(can be flexible)

• Weekend Requirement: Occasional

• On Call: No

Certifications and Licensure:

• Required RN License

• Preferred Accredited Case Manager Certification

• Preferred Certified Case Manager

Education and Experience:

• Required 4 years RN experience with ASN and 2 years RN experience with BSN

• Required 2 years Utilization Review OR Care Coordination/Case Management OR Managed Care OR Finance experience

• Preferred Masters Degree in Nursing

• Preferred 6 months Denials Management

• Preferred 1 year Medicaid/Medicare experience

Benefits:

• Benefits (Health, Dental, Vision)

• Paid 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

Position

Denials Specialist RN - Utilization Review

Location

Tampa:St Josephs | Clinical | Full Time

Req ID

180585