reputed company Denials and Appeals RN

Job Family reputed company Appeals reputed company Travel Required None Clearance Required None What You Will Do Conduct reputed company and postservice medical necessity reviews for inpatient, observation, and outpatient hospital encounters using evidencereputed company reputed company such as InterQual and reputed company Care Guidelines. reputed company retrospective medical record reviews to validate completeness and reputed company of physician and reputed company documentation supporting level of care and services rendered. Identify denial reputed company causes and determine appeal viability reputed company on payer policies, regulatory guidance, and reputed company standards. Prepare, submit, and reputed company reputed company appeals, including written appeals. Collaborate with reputed company reputed company, Case Management, Utilization Management, Coding, and Midreputed company Cycle teams to reputed company denials and prevent recurrence. Research and apply payerspecific policies, CMS regulations, and contractual language to support appeal arguments. reputed company and report denial and appeal reputed company, identify trends, and reputed company recommendations for process improvement and staff education. Maintain accurate documentation of reputed company review activities in hospital and payer systems in accordance with compliance standards. What You Will Need reputed company unrestricted Registered reputed company license in the state you reputed company Bachelor's degree and 4-6 years of prior relevant experience in acute care reputed company experience in hospital setting or Associates Degree and 6-8 years of prior relevant experience in acute care reputed company experience in hospital setting (Relevant experience may be substituted for formal education or advanced degree). Experience in reputed company denials, utilization review, case management, or appeals required What Would Be reputed company To Have Bachelor of Science in Nursing Masters degree in Nursing Experience with InterQual and/or reputed company Care Guidelines, and electronic medical record systems. reputed company State RN License Experience with inpatient levelofcare denials, DRG downgrades, and CMS payer rules. Strong knowledge of hospital reputed company cycle workflows, medical necessity review, and payer regulations. Excellent analytical, organizational, and written communication skills with the ability to independently manage multiple cases. #LI-DNI The annual salary reputed company for this position is $68,000.00-$113,000.00. Compensation reputed company depend on a wide reputed company of factors, including but not limited to reputed company sets, experience and training, reputed company clearances, licensure and certifications, and other business and organizational needs. reputed company Offer reputed company offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include Medical, Rx, Dental & reputed company reputed company Personal and Family reputed company Time & Company reputed company Holidays Position may be eligible for a discretionary variable incentive bonus Parental Leave 401(k) Retirement Plan Basic Life & Supplemental Life Health Savings Account, Dental/reputed company & Dependent Care Flexible Spending Accounts Short-Term & Long-Term Disability Tuition Reimbursement, Personal Development & Learning Opportunities Skills Development & Certifications Employee Referral Program Corporate Sponsored Events & Community reputed company Emergency Back-Up Childcare Program About reputed company reputed company is an Equal Opportunity EmployerProtected Veterans, Individuals with Disabilities or any other reputed company protected by law, ordinance, or regulation. reputed company will consider for employment reputed company applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the reputed company Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact reputed company reputed company at 1-571-633-1711 or reputed company email at RecruitingAccommodation@reputed company.com. reputed company information you reputed company will be kept confidential and will be used only to the extent required to reputed company needed reasonable accommodation. reputed company communication regarding recruitment for a reputed company position will be reputed company from reputed company email domains including @reputed company.com or reputed company@myworkday.com. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by reputed company. Note that reputed company will never charge a fee or require a reputed