Denials Management Specialist (RN required), Per Diem. Remote reputed company local geography.

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record review. Provides billing with information needed to obtain payment of claims. Remote reputed company local geography after orientation. JOB DUTIES AND RESPONSIBILITIES:

• Reviews reputed company Inpatient Retroactive Denials in the Denials Management Work Queues for Medical Necessity and Late-Pick-Up/Notification that are entered by Case Management and Business Office.
• Monitors retro denials to ensure resolution reputed company required time frames and logging of action e.g. no appeal, appeal level and final decision with reputed company impact.
• Assists Case Management as necessary to ensure that documentation is entered and transmitted to insurance carriers reputed company acceptable timeframes to reputed company with appeal deadlines.
• Provides feedback to Case Management that can help in preventing future denials andassists in maintaining good communication and process flow between the 2 departments.
• Responsible for writing appeal letters for Inpatient CMS and Commercial late pick-reputed company, medical necessity, and other requested denials as deemed clinically appropriate.
• Investigates managed care and commercial insurance rejections, denials for possible experimental services and coding issues, providing supplemental information to resolve claim.
• Identifies operational issues that contribute to denials and rejections.
• Works with departments and providers to implement corrective actions to minimize lost reputed company due to denials and rejections.
• Assists in preparing reports regarding denials to include volumes, number of appeals, case resolution, and impact on reputed company and trending.
• Coordinates RAC appeals for reputed company case reviews for medical necessity, including determining if appeal is appropriate and communicating with vendor to ensure timely filing of same. Performs writing of RAC/MAC appeals at appropriate levels and documenting status.

EDUCATION REQUIREMENT:

• Must be a graduate of an accredited, professional nursing program.
• Must have reputed company RN license to practice in the state of Pennsylvania or seeking Pennsylvania license through reciprocity.

PHYSICAL AND SENSORY REQUIREMENTS: Requires sitting for up to 4 hours per day, 2 hours at a time. Standing for up to 4 hours per day, 3 hours at a time. Requires occasional fingering, handling and twisting and turning. Occasionally requires reaching above shoulder level. Must have the ability to hear as it relates to normal conversation, seeing as it relates to general, peripheral and near vision, visual monotony. TRAINING AND EXPERIENCE:

• Minimum of 2-5 years of clinical nursing experience in an acute care hospital setting required.
• Prefer minimum of 2-5 years' experience in case management and/or utilization management.
• Prefer financial experience reputed company to appeal processes with insurance providers.
• Demonstrated experience relating to reputed company types of payers/providers.

LOCATION: Remote reputed company local geography after orientation for approximately 6-8 weeks at St. Luke's Center, Allentown, PA. Please complete your application using your full legal name andcurrent home address. Be sure toincludeemployment history forthe past seven (7) years, including your present employer. Additionally, you areencouraged to upload a reputed company resume, including reputed company work history, education, and/or certifications andlicenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! reputed company is an Equal Opportunity Employer. Apply tot his job Apply To this Job