We Are Hiring
Registered Nurse Specialist - Denials and Appeals- Case Management 002 - FT Days Monday through Friday 7:30-4:00 p.m. - St Mary's Hospital - Amsterdam, NY
Why Join Ascension?
St. Mary’s Healthcare, based in Amsterdam, New York, provides a full range of outpatient services while featuring an award-winning acute care hospital, three Urgent Care Centers, multiple primary and pediatric health centers, specialty care including Cancer Medicine, Gastroenterology, OB-GYN, ENT, Surgical and Urology, inpatient and outpatient mental health services and a 160-bed nursing home. The organization has earned outstanding national rankings for excellence in medicine and patient safety.
St. Mary's Healthcare is part of Ascension, a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As one of the leading non-profit and Catholic health systems in the U.S., Ascension is committed to delivering compassionate, personalized care to all, especially to those most in need. In FY2018, Ascension provided nearly $2 billion in care of persons living in poverty and other community benefit programs.
What You Will Do
As a Registered Nurse Specialist-Denials and Appeals with St. Mary's Hospital - NY, you will have the opportunity to serve as the central point person for all commercial and government claim recovery activities providing efficient management of work flow related to commercial denial/appeal and recovery audit activities.
- Uses clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.
- Reviews commercial and government claim denials and audit requests and coordinates attempts to overturn denials by drafting appeals, negotiating with payers, or following up with payer utilization review departments in attempts of obtaining authorizations and claim payment.
- Establishes and maintains positive and cooperative relationships with medical staff and care coordination leaders to ensure ongoing compliance with utilization review guidelines.
- Collaborates with managed care department to code billable items for reimbursement. Collaborates with appropriate staff to secure information for billable items.
- Analyzes and creates reports to capture payer denial trends and volume, to support patient financial services and clinical leaders in the revenue cycle.
- Coordinates projects and audits to improve processes related to revenue cycle, efficiency of charging and billing, and collection efforts.
- May educate case management staff and other departments regarding payer changes and denial/appeal process.
What You Will Need
- Required Credential(s):
- Registered Nurse credentialed from the New York Board of Nursing obtained prior to hire date or job transfer date.
Education & Work Experience:
- Diploma from an accredited school/college of nursing required.
- Desire to work in a very integrated multidisciplinary team with communication being of utmost important.
- Experience with denials and appeal writing.
- Advanced knowledge of level of care criteria (Milliman and/or Interqual) .
Equal Employment Opportunity
St. Mary’s Hospital is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status, sexual orientation or any other status protected under local, state or federal laws.
State and Federal laws prohibit discrimination on the basis of race, creed, color, religion, gender, national origin, age, disability, marital status or sexual orientation.
Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.
St. Mary's Healthcare participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.