RN Clinical Denials Appeals Specialist
US-CO-Centennial
mountain-commonspirit_external
Req #: 92688
Type: Full-Time
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Overview: CommonSpirit Health Mountain Region is committed to building healthier communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen-both inside our hospitals and out in the community. With locations throughout Colorado, Utah, and Kansas, we deliver the same high standard of care to our employees as we do to our patients. Our 20 hospitals, emergency and urgent care centers, home care and hospice, Flight for Life ColoradoTM , telehealth and over 240 physician practices and clinics offer endless opportunities! Here, you can grow your career and impact the people in the communities you serve. CommonSpirit Health is one of the nation's largest nonprofit, faith-based health systems, with a team of over 150,000 employees and 25,000 physicians and advanced practice clinicians. CommonSpirit operates more than 2,200 care sites and 140 hospitals, serving some of the most diverse communities across the nation, letting humankindness lead the way. Responsibilities: You have a purpose, unique talents and now is the time to embrace it, live it and put it to work. We value incredible people with incredible skills - but your commitment to a greater cause is something we value even more. This is the heartbeat of our organization and your time will be spent in a supportive, team environment with resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites with external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion of medical records and utilization review processes. Identifies areas for documentation and/or process improvement and promotes pro-active documentation compliance for reimbursement. Demonstrates dynamic ability to adapt to ongoing changes within the health insurance industry in order to effect and implement positive changes for financial growth. Maintains knowledge of care guidelines related to severity of illness and risk of mortality, CMS rules, and insurance regulations. Accepts and completes projects as assigned. Communicates and collaborates with other departments and maintains active presence in inpatient and outpatient settings. Qualifications: In addition to bringing humankindness to the workplace each day, qualified candidates will need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse. 3 years with progressive experience in utilization review, preferred. Prior experience writing clinical denial appeal letters required. License Required: Curent RN License in the State of employment Physical Requirements Medium Work - exert/lift up to 50 lbs. force occasionally, and/or up to 20 lbs. frequently, and/or up to 10 lbs. constantly *Days/hours- Monday-Friday, 8am-5pm MST* **This is a remote role. Primary residence must be in CO, UT, or Kansas.** Must have Clinical Denials experience. Please make sure it's clearly written out in your resume.
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