Clinical Denials Specialist

4 weeks ago


Owensboro, Kentucky, United States Owensboro Health Full time

Job Summary

The Clinical Denials Coordinator plays a crucial role in managing the initial clinical denials process for hospital patients. This involves reviewing and analyzing payer denials, developing strategies for resolution, and communicating with insurance companies, providers, and case managers.

Key Responsibilities

  • Reviews and analyzes payer denials to determine the cause and develops strategies for resolution.
  • Communicates timely with insurance companies, providers, case managers, and other departments to resolve denials and secure payments.
  • Maintains detailed documentation of all denials, causes, appeal status, and outcomes.
  • Generates and analyzes reports on denial trends, recovery rates, and other relevant metrics to identify opportunities for improvement.
  • Provides education and training to case managers, providers, and other healthcare team members on documentation practices and denial prevention strategies.
  • Collaborates with clinical and administrative teams to develop and implement process improvements to reduce denial rates.

Requirements

  • Associate's degree or higher or Diploma in Nursing required upon hire.
  • Bachelor's degree or higher in Nursing required within 5 years of employment in this position.
  • A minimum of 3 years' relevant experience required.
  • RN - Licensed as a Registered Nurse. Eligible to practice nursing in the State of Kentucky required upon hire.

Core Commitments

Owensboro Health is committed to INTEGRITY, RESPECT, TEAMWORK, INNOVATION, SERVICE, and EXCELLENCE in all aspects of our work.



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