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Denials Management RN

2 months ago

Rancho Cordova, United States Dignity Health Full time

Overview

Dignity Health one of the nation’s largest health care systems is a 22-state network of more than 9000 physicians 63000 employees and 400 care centers including hospitals urgent and occupational care imaging and surgery centers home health and primary care clinics. Headquartered in San Francisco Dignity Health is dedicated to providing compassionate high-quality and affordable patient-centered care with special attention to the poor and underserved. For more information please visit our website at www.dignityhealth.org. You can also follow us on Twitter and Facebook.

Responsibilities

The Denials Management RN is responsible for the following:

  • receiving, processing and documenting all concurrent denials for assigned facilities. The RN has an integral role within the revenue cycle by providing clinical expertise in the denials management process.

  • performs a root cause analysis of the concurrent denial, formulates and implements a plan for addressing the specific root cause for that denial, identifies gaps in processes that lead to concurrent denials, documents and communicates findings to management. Recommends and provides education in collaboration with their manager.

  • follows a standardized approach to managing denials in order to achieve the organizational objectives of financial stewardship and patient advocacy through accurate billing.

  • using professional judgment, independent analysis and critical-thinking skills to apply clinical guidelines, policies, and payer knowledge to ensure the best possible financial outcome.

  • accountable for demonstrating a strong commitment to promoting quality every day by demonstrating our organizational values of: Compassion, Inclusion, Integrity, Excellence, and Collaboration.

We offer the following benefits to support you and your family:

  • Health/Dental/Vision Insurance

  • Flexible spending accounts

  • Voluntary Protection: Group Accident Critical Illness and Identity Theft

  • Adoption Assistance

  • Free Premium Membership to Care.com with preloaded credits for children and/or dependent adults

  • Employee Assistance Program (EAP) for you and your family

  • Paid Time Off (PTO)

  • Tuition Assistance for career growth and development

  • Retirement Programs

  • Wellness Programs

Qualifications

Required:

  • Minimumthree (3)yearsclinical experience as Registered Nurse (RN) required.

  • RN license

  • BLS required within 3 months of hiring if located within hospital

Preferred:

  • Graduate of an accredited school of nursing (Bachelor's Degree in Nursing (BSN)) or related healthcare field.

  • 5 years of RN experience preferred.

  • Minimum Three (3) years utilization management experience preferred

  • Denials management experience preferred.

  • Care Management certification (CCM or ACM) preferred

Pay Range

$46.96 - $68.10 /hour

We are an equal opportunity/affirmative action employer.