Clinical Appeals Registered Nurse
1 week ago
The Clinical Appeals Registered Nurse embodies the core mission, vision, and values of Northwestern Memorial Healthcare. This role is committed to upholding the organization's Code of Ethics and Corporate Compliance Program while adhering to all relevant policies, procedures, guidelines, and regulatory standards.
Key Responsibilities:
- Utilize clinical expertise to assess and interpret documented patient treatments.
- Manage and facilitate appeals related to insurance denials post-payment, including escalation to payers and other methods to ensure reimbursement.
- Oversee audits, particularly those conducted by the Centers for Medicare & Medicaid Services (CMS).
- Provide comprehensive financial data and analysis for both internal and external reporting.
- Ensure readiness for audits and respond effectively to all audit inquiries.
This position plays a vital role in ensuring financial integrity and compliance within the healthcare setting.
AA/EOE
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