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Maitland, United States Adventhealth Full timeAll the benefits and perks you need for you and your family: Benefits from Day One Paid Days Off from Day One Student Loan Repayment Program Career Development Whole Person Wellbeing Resources Mental Health Resources and Support Our promise to you: Joining AdventHealth is about being part of something bigger. It’s...
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Maitland, United States Adventhealth Full timeAll the benefits and perks you need for you and your family: Benefits from Day One Paid Days Off from Day One Student Loan Repayment Program Career Development Whole Person Wellbeing Resources Mental Health Resources and Support Our promise to you: Joining AdventHealth is about being part of something bigger. It’s...
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Clinical Documentation Manager
1 month ago
Maitland, United States Adventhealth Full timeAll the benefits and perks you need for you and your family: Benefits from Day One Paid Days Off from Day One Student Loan Repayment Program Career Development Whole Person Wellbeing Resources Mental Health Resources and Support Our promise to you: Joining AdventHealth is about being part of something bigger. It’s...
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RN Homecare
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Maitland, FL, United States Surgical Care Affiliates Full timeRegistered Nurse Operating Room - Maitland Surgery CenterOverview Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a...
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Maitland, FL, United States Surgical Care Affiliates Full timeRegistered Nurse Operating Room, Pool - Maitland Surgery CenterOverview Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around...
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RN PreOp PACU, Pool
1 month ago
Maitland, FL, United States Surgical Care Affiliates Full timeRN PreOp PACU, Pool - Maitland Surgery CenterOverview Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal:...
RN Denial Prevention Specialist
2 months ago
**All the benefits and perks you need for you and your family**+ Benefits from Day One+ Paid Days Off from Day One+ Student Loan Repayment Program+ Career Development+ Whole Person Wellbeing Resources+ Mental Health Resources and Support+ Pet Insurance*+ Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense)**Our promise to you:**Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better.**Schedule:** Full-Time/Day**Shift** : Monday-Friday 8:00am-5:30pm**The role you’ll contribute:**The Denial Prevention RN enhances AdventHealth’s ongoing mission of providing excellent patient revenue management service within an ever-changing and complex healthcare system. Our team is comprised of a group of diverse experienced registered nurses with extensive clinical knowledge. Our goal is to prevent claim denials for AdventHealth's extensive patient population by meeting regulatory requirements and collaborating with stakeholders. This team also reviews surgical claims prior to admission for patient statusing and denial avoidance. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.**The value you’ll bring to the team:**+ Reviews and responds to all types of Medicare audits such as; ADR FCSO, RAC, CERT, Targeted Probe & Educate, Livanta QIO, SSR (Short Stay Reviews), HWDRG (Higher Weighted DRG), First Coast, SMRC Noridian, ZPIC+ Performs pre-operative surgical reviews for high audit risk surgeries for all payers based on a specific algorithm at least 7 days pre-operatively. Collaboratively works with Pre-Access, IP auth teams, Utilization Management, Physician Advisors, Nursing, Physicians, Care Management, Coding, and others to ensure appropriate patient statusing based on data and information compilation.+ Performs C-indicator/IP only surgical reviews for Medicare and Managed Medicare payers per regulatory rules and regulations. Reaches out to the appropriate stakeholders to make sure that the patients are in the right status pre-operative and/or in the immediate post-operative period.+ Performs Medical Necessity Reviews based on regulatory LCD/NCD/LCA criteria to verify that patients are in the right status and to protect AdventHealth revenue stream so that they are compensated as appropriate.+ Completes Prior Authorization Reviews for Medicare as required for payment by Medicare that requires pulling all scheduled procedures that meet this requirement 30 days pre-procedure, reviewing the EMR, completing a CMS regulatory review, obtaining all missing information, working with the provider office to secure mandated information, and electronic submission of all required information to the QIO.+ Institute provider outreach when needed to include education, telephonic consultations, and meetings as required to educate on denial prevention, payer authorization, and associated subjects to ensure we are statusing patients correctly based on all regulatory and compliance standards.+ Collaboration with all stakeholders to meet regulatory and payer contractual requirements to achieve accurate patient status to prevent payer denials concurrently and retrospectively.Qualifications**What You Will Need:**+ Bachelor’s degree in Nursing, Management, or related healthcare field such as: healthcare management, risk management or social work.+ Three years’ experience in an acute clinical setting including, but not limited to, acute inpatient hospital, managed care, and/or Center for Medicare and Medicaid Services.+ Current valid State of Florida or multi state license as a Registered NurseThis facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.**Category:** Patient Financial Services**Organization:** AdventHealth Orlando**Schedule:** Full-time**Shift:** 1 - Day**Req ID:** 24023663We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.
