Utilization Management Nurse Specialist

1 week ago

Salt Lake, Utah, United States Myriad Genetics Full time
Job Title: Utilization Management Nurse

This is a US-based remote position at Myriad Genetics, Inc.

Overview

We are seeking an experienced Nurse Advocate to join our team, responsible for leading and performing individual work on appeals for erroneous denials and obtaining patient chart notes. This role will be part of an elite team building a culture of revenue cycle excellence and continuous improvement, influencing the entire department to deliver material revenue and profit to the company.

Responsibilities

  • Understand Myriad products and their recommended use in patient populations.
  • Document for payors how a patient is appropriate for coverage for the test their doctor ordered.
  • Understand insurance denial reasons on claims and prior authorizations, and insurance appeal processes for claims and prior authorizations.
  • Be a strong advocate for patients to challenge erroneous denials and obtain medical records from clinician offices.
  • Communicate effectively with patients, clinicians, and payors to prioritize appropriate patient coverage for testing ordered by their clinician.
  • Prepare and provide training for the Revenue Cycle team on how to replicate processes designed by the Nurse Advocate to challenge erroneous insurance denials and obtain medical records from clinician offices.
  • Assist Revenue Cycle leaders with measuring predictors of success in gaining coverage and identify root causes for denials. Coordinate payor reviews with Revenue Cycle and leaders to meet company goals to reduce unpaid tests.
  • Develop relationships with Revenue Cycle vendors to ensure vendor performance and quality meets or exceeds standards set for those relationships.
  • Drive a culture of continuous improvement that engages the Revenue Cycle Management team and participates in the Quality Assurance plan.

Qualifications

  • RN is required.
  • 5+ years of related experience with 3+ years as a nurse reviewer at a payor required.
  • Demonstrated ability to interact with clinician offices and clinicians to overcome barriers to appropriate patient care.
  • Intermediate knowledge of Microsoft Word and Excel.
  • Working knowledge of ICD-10, CPT and HCPCS coding, HIPAA regulations, and insurance appeal procedures.

Physical Requirements

Lifting Requirements - light work or exerting up to 20 pounds of force frequently. Physical Requirements - stationary positioning, moving, operating, ascending/descending, communicating, observing, pushing or pulling, and reaching. Use of equipment and tools necessary to perform essential job functions.

EEO

We recognize that our people are our strength and the diverse talents they bring to our global workforce are directly linked to our success. We are an equal opportunity employer and place a high value on diversity and inclusion at our company. In hiring and all other employment decisions, we prohibit discrimination and harassment on the basis of any protected characteristic, including race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, marital or veteran status, pregnancy or disability, or any other basis protected under applicable law. In accordance with applicable law, we make reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as any mental health or physical disability needs.

Equal Employment Opportunity

We are committed to creating an inclusive and diverse work environment that values and respects all individuals. We do not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other protected characteristic.

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