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RN Appeals Denials Specialist - FT Remote

We Are Hiring

Great opportunity to work remotely!

 

What You Will Do:

As an Associate with St. Agnes Healthcare-MD, you will have the opportunity to provide health care services regarding admissions, case management, discharge planning and utilization review.

 

Responsibilities:

  • Supports the efforts of the Care Management Department through the avoidance, investigation, and appeal of denials of days of care and/or patient care services.
  • Networks with insurers to resolve those denial issues that can be managed successfully without appeal.
  • Serves as a resource for the care managers, insurance carriers, admitting and accounts receivable.
  • Provides ongoing education to ancillary departments in an effort to maximize denial management and the overturn of denied days.
  • Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
  • Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.

 

Why Join Saint Agnes?

Saint Agnes Healthcare serves the greater Baltimore area and employs more than 3,000 associates. Saint Agnes offers a full range of services through its operation of a 254-bed, full-service teaching hospital, Saint Agnes Medical Group, Seton Imaging Center, and Saint Agnes Foundation. Partnerships throughout the community have positioned Saint Agnes to provide support to individuals when and where they need it most. Saint Agnes strives to ensure the vitality and health of the community.

Saint Agnes 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 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 Need:

 

  • Graduate of a Registered Nursing Program.
  • Active RN License
  • Five years’ clinical experience required; Med/Surg and/or ICU preferred.
  • Auditing experience is required.  Prior experience with denials and appeals processing, utilization review, or payor auditing strongly preferred.
  • Knowledge of insurance regulations/contracts, managed care, CMS, and ER Autopay desired.

Equal Employment Opportunity

We are an Equal Opportunity Employer.
 
As an equal opportunity employer, Saint Agnes Hospital does not discriminate on the basis of race, color, national origin, sex, sexual orientation, religion, age, mental or physical disability, marital status, veterans status, military service, or any other legally protected status.
 
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.
Job ID: 375142
Category: Nursing
Facility: MDBAL St Agnes Healthcare
Ministry: Saint Agnes Healthcare, MD
Location: Halethorpe, MD

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