Hybrid RN: Denials & Utilization Review Specialist

BayCare Health System; Tampa (FL); Hybrid; USD 70,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Tuition reimbursement

401k match

Annual bonus

Job summary

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

Qualifications

• 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.

Responsibilities

• 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.

Skills

Care coordination

Denials management

Collaboration

Clinical documentation

Education

ASN degree

BSN degree

Masters preferred

Tools

Accredited Case Manager Certification

Certified Case Manager

Job description

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