Denials/Appeals RN Coordinator
Job Description
Full Job Description
Shift: Day
Working Hours: M-F, 8-5PM
Summary:
Responsible for managing Inpatient denials by conducting a comprehensive review of clinical documentation to determine if an appeal is warranted. Where warranted, the Denials Management RN will collect, organize and present pertinent clinical information to third party payers. The Denials Management RN will also process and track clinical denials for the healthcare system.
Other information:
Bachelor’s degree in Nursing or an equivalent degree in a related discipline required, as well as a current state issued RN license. Must be able to interpret and utilize MCG and/or other criteria tools. Knowledge of third party payer regulations related to Utilization Review is preferred.
This job will be authorized 80.00 hours bi-weekly.