Sorry, this job is no longer available.

(Loading More Opportunities)

REGISTERED NURSE (RN) DENIALS AND APPEALS COORDINATOR

Responsible for supporting case management and compliance functions and serves as an internal consultant.

Responsibilities Role Specific Responsibilities

  • Compiles and analyzes medical necessity denial data from three facilities to determine level of appeal needed, implements appeals, and performs follow up processes.
  • Develops, coordinates and presents focused education sessions for SIH personnel and medical staff related to medical necessity denials and other process issues.
  • Researches and compiles regulatory information/data and provides written and oral reports to senior leadership and medical staff.
  • Adapts to regulatory changes and develops improvement opportunities.
  • Participates in the denial management process, including medical necessity review for Recovery Audit Contractor (RAC).
  • Acts as the case management liaison for participation on the RAC teams.
  • Prepares multi-level written appeals.
  • Provides second level review for non-billable admissions and coordinates notification of confirmed cases to business office.
Qualifications Education

  • Bachelor’s degree
  • Licenses and Certification

  • Current Illinois RN License
  • Experience and Skills

  • Technical Experience: 3 years
  • #PIQnursing

    PandoLogic. Keywords: Registered Nurse (RN), Location: Carbondale, IL - 62901
    Posted
    09/15/2021
    Type
    Full time
    Location
    Carbondale, IL 62901, US