Reimbursement Appeals Nurse Specialist

4 hours ago


Philadelphia, Pennsylvania, United States Genesis Healthcare, Inc. Full time
Job Summary

We are seeking a highly skilled Reimbursement Appeals Nurse to join our team at Genesis HealthCare, Inc. This role requires a strong analytical mind and excellent communication skills to effectively review patient medical records and write compelling appeal arguments.

Key Responsibilities
  • Conduct comprehensive analytical reviews of patient medical records to identify reasons for denials and develop sound appeal arguments.
  • Utilize clinical and regulatory knowledge to provide convincing appeal arguments and justify payment of services.
  • Identify trends in charts resulting in denials and report them to the denial management team.
  • Participate in Administrative Law Judge hearings and provide testimony as necessary.
  • Request additional supporting clinical evidence to support appeal arguments when existing resources are inadequate.
  • Ensure compliance with HIPAA and maintain accurate tracking records of appeals management activities.
Requirements
  • Registered Nurse with significant experience in the Healthcare Industry.
  • Knowledge of regulatory requirements for reimbursement and reasons for denials.
About Genesis HealthCare, Inc.

Genesis HealthCare, Inc. is a leading provider of healthcare services, committed to delivering high-quality care to our patients. We are an equal opportunity employer and welcome applications from diverse candidates.



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