RN Revenue Cycle Specialist — Denials & Appeals

Prisma Health; Greenville (SC); Presencial; USD 85 000 - 110 000; Tempo integral

Resumo da oferta

Prisma Health in Greenville, South Carolina is seeking an experienced registered nurse to coordinate and resolve clinical denials and appeals, while auditing revenue cycle processes and educating staff on reimbursement issues.

The role partners with Utilization Review and Outcomes Management, monitors payor trends, and produces tracking reports. A current RN license is required to practice in the state.

Qualificações

• Education - Associate degree in Nursing.
• Experience - Five (5) years Nursing experience in a hospital setting. Experience in in-patient, out-patient or physician coding experience, revenue cycle and/or utilization management experience preferred.
• Holds a current RN license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Responsabilidades

• Coordinate and resolve denials and appeals for the system-wide revenue cycle.
• Collaborate with Utilization Review / Outcomes Management to resolve in-house denials and appeals.
• Monitor denial and appeals trends and report to management for process improvement.
• Produce denials and appeals tracking reports for Management and Departments.
• Provide comprehensive training on denial resolution and appeals processing to Prisma Health staff.
• Assist leadership with strategic goals to reduce denials volume.
• Maintain knowledge of current trends in healthcare related to denials and appeals.

Conhecimentos

Nursing experience

Coding experience

Revenue cycle

Utilization management

Formação académica

Associate degree in Nursing

Descrição da oferta de emprego

Prisma Health in Greenville, South Carolina is seeking an experienced registered nurse to coordinate and resolve clinical denials and appeals, while auditing revenue cycle processes and educating staff on reimbursement issues.

The role partners with Utilization Review and Outcomes Management, monitors payor trends, and produces tracking reports. A current RN license is required to practice in the state.