RN Denials / Appeals Mgmt Specialist Job Listing at MedStar Medical Group in Baltimore, MD (Job ID req36734)

Description

**At this time, only registered nurses with prior Utilization Review or Appeals experience will be considered. Applicant must be able to commute to Baltimore, MD for 3 months of on-site training**

General Summary of Position
Responsible for coordinating and monitoring the denial management and appeals process. Combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Collaborates with physicians, Utilization Review RN's, Case Managers, revenue cycle personnel and payers to appeal denials.

Primary Duties and Responsibilities

Minimum Qualifications
Education

• Associate's degree in Nursing required and
• Bachelor's degree in Nursing preferred

Experience

• 3-4 years 2 to 3 years clinical experience required and
• 3-4 years 2 to 3 years UR experience in health care setting preferred and
• 1-2 years 2 years background/experience in hospital audits preferred

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure RN license in the District of Columbia or the State of Maryland depending on work location Upon Hire required and
• Certification in Utilization review, case management and health care quality Upon Hire preferred and
• If MFM, maternal fetal medicine (MFM) coding and billing yearly seminars Upon Hire preferred

Knowledge, Skills, and Abilities

• Excellent verbal and written communication skills.
• Persuasive writing skills required.
• Working knowledge of Office Suite software applications preferred.

This position has a hiring range of $87,318 - $157,289