Under minimal supervision, this RN specializes in follow-up of denied and rejected claims from all commercial, contracted and non-contracted payers, including preparing appeal letters. Working within a centralized department, reviews all denials for medical necessity and appeal ability utilizing clinical judgment and applying appropriate medical necessity criteria. Provides clinical utilization management expertise to provide education, formal and informal and facilitates denial management strategies. Serves as a liaison to key customers that include, hospital ancillary departments, physicians, and payers.
This is a great place to work where you can use your clinical knowledge and experience to support the medical necessity of our patients being admitted to the hospital. You fight for the services that were performed and what should be appropriately paid for. We currently are working remotely. Yes sometime this could change but as of now it is remotely.
Education And Experience
- Registered Nurse with a valid, unrestricted, State of Michigan License required.
- Minimum 3-5 years of clinical experience required.
- Bachelor of Science Nursing required or three years Denial/Appeal/Utilization Management experience.
- Knowledge of hospital billing and payer regulations, including criteria for patient status determination, and tools/software used for determination.
Additional Information
- Organization: Corporate Services
- Department: Ascension Payor Audit CDRU
- Shift: Day Job
- Union Code: Not Applicable