Clinical Appeals Registered Nurse
2 weeks ago
At Northwestern Memorial Healthcare, we prioritize every patient interaction, fostering a positive work environment that distinguishes us as a leader in the healthcare sector. Joining our team means contributing to our mission of enhancing healthcare quality across our system.
Position SummaryThe Clinical Appeals Registered Nurse embodies the mission, vision, and values of Northwestern Memorial Healthcare, adhering to our Code of Ethics and Corporate Compliance Program while complying with all relevant policies and regulatory standards.
This role involves utilizing clinical expertise to assess and interpret documented patient treatments, managing appeals for insurance denials after payment. This includes payer escalations and other methods to ensure payment recovery. The position is also responsible for overseeing audits, particularly those from the Centers for Medicare & Medicaid Services (CMS), and providing essential financial data and analysis for both internal and external reporting, ensuring readiness for audits and responding to all audit inquiries.
QualificationsRequired:
- Current Licensed Registered Nurse.
- A minimum of 3 years of experience in an Acute Care Setting or in an Audit/Appeals role.
- Proficient understanding of Milliman/Interqual guidelines.
- Strong analytical skills, effective communication abilities, and capacity to collaborate across departments.
Preferred:
- Bachelor of Science in Nursing (BSN).
- Familiarity with Medicare reimbursement policies.
Northwestern Memorial Healthcare is an equal opportunity employer, committed to a diverse workforce and does not discriminate in hiring or employment based on any protected status.
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