Denial Recovery Specialist

4 weeks ago

Leesburg, Florida, United States UF Health Full time

Overview

UF Health Leesburg Hospital has been serving the healthcare needs of our community for many years, offering advanced cardiac care, including one of the largest cardiothoracic surgery programs in the state.

The American College of Cardiology has recognized UF Health Leesburg Hospital for its demonstrated expertise and commitment in treating patients with chest pain by awarding a Chest Pain Center Accreditation with Primary PCI and Resuscitation.

We take pride in providing progressive, innovative technology, along with building strong relationships with patients, families, physicians, and residents of the communities we serve.

Responsibilities

Under the general supervision of the Utilization Management Director, the Denial Recovery Coordinator is responsible for hospital-wide management and coordination of utilization and external review activities related to payor issues to ensure an active and effective utilization and denial management program.

All duties are performed in accordance with the utilization review plan, Federal and State guidelines, as well as The Joint Commission standards.

Qualifications

Education

Bachelor's Degree preferred

Licensure/Certification/Registration

Florida Registered Nurse license

Special Skills/Qualifications/Additional Training/Experience Required

Must be able to read, speak, and write in English

Min of 2 years' experience performing utilization review in a hospital setting, for a third-party payor or other review agency or organization

Knowledge of diagnostic related groups (DRGs), Federal and State guidelines, commercial and other payor groups and ICD-10-CM coding preferred

Must possess strong written and verbal communication skills

Ability to type and use computer required

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