Remote RN: Clinical Denials & Utilization Coordinator

Jackson Health System; Miami (FL); Ibrido; USD 65.000 - 90.000; Part-time

Descrizione del lavoro

Jackson Health System in Miami, FL seeks a Clinical Denials Coordinator to support the Utilization Review team within Revenue Cycle. Responsibilities include reviewing denied accounts, identifying trends, and leading efforts to improve recovery outcomes across Emergency Dept and Inpatient UR workflows.

The role requires 3–5 years of related experience, RN background (ED/ICU/IR/OR preferred), InterQual review experience, and a Bachelor's in Science.

Competenze

• 3–5 years of related experience.
• Preferred payer experience in utilization review, denials, audits and/or appeals.
• RN experience in ED/ICU/IR/OR is preferred.
• Experience with InterQual reviews is a plus.

Mansioni

• Audit denied or potentially denied accounts to determine true denial reason.
• Collaborate with denial agencies on identifying trends and reporting to denial committees.
• Work with payors and JHS managed care to resolve denials and improve recoveries.
• Coordinate denial committee meetings at each facility and ensure timely reviews and reports.

Conoscenze

Denials management

Auditing

InterQual reviews

Payer coordination

Formazione

Bachelor's in Science

Master's degree preferred or ARNP

Certification as ARNP or Foreign Medical Graduate

Strumenti

InterQual reviews

Descrizione del lavoro

Jackson Health System in Miami, FL seeks a Clinical Denials Coordinator to support the Utilization Review team within Revenue Cycle. Responsibilities include reviewing denied accounts, identifying trends, and leading efforts to improve recovery outcomes across Emergency Dept and Inpatient UR workflows.

The role requires 3–5 years of related experience, RN background (ED/ICU/IR/OR preferred), InterQual review experience, and a Bachelor's in Science.