Overview :
The clinical denial management nurse is responsible for completing, tracking, and reporting clinical denials at an enterprise level between all UF hospitals.
Reporting to Enterprise Denial Nurse Manager, this role serves as a support to revenue cycle including clinical departments, finance, accounting, compliance, patient financial services, revenue integrity, managed care, utilization review, and patient access.
The clinical denial management nurse is considered a clinical expert in denial management and ensures all denied claims are accurately worked from a clinical perspective, and appropriately appealed to secure maximum reimbursement and minimize organizational write-offs.
REMOTE JOB.
Qualifications :
Required Education : :
High School Diploma or GED
Preferred Education : :
Bachelor's Degree in Nursing (BSN)
Required Licensure / Certification : :
Licensed to practice nursing (RN) or practical nursing (LPN) in the state of Florida
Preferred Licensure / Certification : :
CPC, COC, RHIT, RHIA, or CCS
Required Experience : :
2-3 years clinical experience as a RN
3-5 years clinical experience as a LPN
Preferred Experience : :
Knowledge or experience related to coding, medical record review, auditing, insurance experience.
Necessary Skills : :
1. Demonstrated knowledge of : Hospital billing and reimbursement, Medicare and Medicaid denials and appeals, third-party contracts, federal and state regulations governing the healthcare industry
2. Excellent critical thinking and analytical skills
3. Attention to detail and ability to complete the job with minimal errors and work independently.
4. Proficient organizational skills
5. Excellent writing and communication skills
6. Ability to prioritize and manage time effectively.
7. Proficient in Microsoft Office Products such as : Outlook, Word, Excel
8. Knowledge of HIPPA guidelines
9. Ability to read and interpret EOBs.
10. Strong research and problem-solving skills
11. High level of comfort with computer systems
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