DENIAL MANAGEMENT NURSE

4 weeks ago

Montgomery AL USA, United States Jackson Hosptial & Clinic Full time

The Denial Management Nurse is responsible for developing and implementing a centralized program to promote greater efficiency with completing, tracking, and reporting clinical denial reviews to determine appropriate appeal of patient accounts. This individual will combine clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and through the retrospective denial of payments for rendered services. Through continuous assessments, problem identification, and education, this individual facilitates the quality of health care delivery in the most cost effective and efficient manner. This individual has highly enveloped knowledge and skills in areas of Medical Necessity, Patient Status Determination, Government and Commercial payor requirements, and Denial Management and Avoidance. Responsibilities include supporting the Denial Avoidance Program by ensuring there is accurate and concurrent clinical analysis of all pre- and post- claims denials within the UW Health system. This individual also provides clinical guidance and participates in the Jackson Hospital & Clinic UM Committee, Denial Management Committee by responding to requests for clinical consultation related to medical necessity denials, writing appeal letters, and other Recovery Audit activities. This individual participates in the Jackson Hospital Utilization Management Committee by providing analysis of utilization- and medical necessity-related denials. The Denial Management Nurse is considered a clinical expert in Denial Management and Avoidance and ensures all denied claims are accurately worked from a clinical perspective, and appropriately appealed to secure maximum reimbursement and minimize organizational write-offs. The incumbent partners with other key stakeholders as appropriate to identify and implement opportunities for improvement in clinical denial avoidance and management by developing training, facilitating quality improvement initiatives, providing structure for additional orientation and competency development. This individual will report to the Director, Case Management and will collaborate closely with leadership and staff within and outside of the case management, utilization management & revenue cycle teams for the purpose of improving clinical, operational, and financial outcomes.

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    Job Description The Denial Management Nurse is responsible for developing and implementing a centralized program to promote greater efficiency with completing, tracking, and reporting clinical denial reviews to determine appropriate appeal of patient accounts. This individual will combine clinical, business, and regulatory knowledge and skill to reduce...

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    Job Description The Denial Management Nurse is responsible for developing and implementing a centralized program to promote greater efficiency with completing, tracking, and reporting clinical denial reviews to determine appropriate appeal of patient accounts. This individual will combine clinical, business, and regulatory knowledge and skill to reduce...

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