Description
Summary
Reviews clinical information and supporting documentation for acute care inpatient Part A services to determine appeal action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned.
Responsibilities
Reviews, assesses, and evaluates all communications received in order to optimize reimbursement.
Evaluates clinical information and supportive documentation prior to initial appeal action in order to optimize reimbursement and utilization of resources.
Prepares response to appeal/request for information based on supporting clinical information in order to enhance reimbursement and maximize customer satisfaction.
Compiles, analyzes, and distributes necessary clinical and financial information and presents reports to other healthcare providers in order to improve performances, and increase awareness of resources consumed related to reimbursement.
Completes assigned goals.
Requirements, Preferences and Experience
Education
Minimum: Ability to type and/or key accurately and have strong organizational skills.
Experience
Preferred: Five years clinical experience and 3-5 years case management or denial management experience.
Minimum: RN, 5 years clinical experience in a clinical care setting.
Licensure, Registration, Certification
Preferred: CCM;RN;CCS
Minimum: RN
Special Skills
Minimum: Excellent communication skills. Advanced computer literacy skills with the ability to type and key accurately.
Training
Minimum: Requires critical thinking and judgement and must demostrates the ability to appropriately use standard criteria established by payers.
About Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.
At Baptist, We Offer:
Competitive salaries
Paid vacation/time off
Continuing education opportunities
Generous retirement plan
Health insurance, including dental and vision
Sick leave
Service awards
Free parking
Short-term disability
Life insurance
Health care and dependent care spending accounts
Education assistance/continuing education
Employee referral program
Job Summary:
Position: 3484 - Specialist-Denial II RN
Facility: BMHCC Corporate Office
Department: HS Denial Mitigation Corporate
Category: Finance and Accounting
Type: Non Clinical
Work Type: PRN
Work Schedule: Days
Location: US:TN:Memphis
Located in the Memphis metro area REQNUMBER: 23531
Compensation Information:
$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
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