We are recruiting for a Claims Denial Nurse to join our Hospital Division in Louisville, KY .
Please note: This position will support clients in the Central Time Zone.
Responsible for denial assessment, analysis of clinical documentation, and formulation of appeal letter when medical necessity and non-clinical denials are received from third party payers (government and non-government). Writes claim appeal letters according to evidence in the medical record and defined appeal process. Ensure timely submission of appeal letters.
Excellent writing skills.
Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
Knowledge of accreditation standards and compliance requirements.
Knowledge of government and non-government payer practices, regulations, standards and reimbursement processes.
Knowledge of established national medical necessity guidelines (InterQual(r) level of care LTAC criteria, Milliman Care Guidelines(r) for LTAC).
Compose appeal letters for the Hospital Division, including Inpatient Rehabilitation Facilities (IRFs).
Ability to review medical, financial and admission criteria documentation to prepare well-written appeal letters.
Ability to communicate whether denial is substantiated or viable after review of medical, financial, and admission documentation.
Regularly review periodicals, web sites and other media for changes in current guidelines.
Provide educational material relative to types of claims and errors identified during review of medical and financial documentation.
Recommend projects that promote documentation improvement (i.e. form, ProTouch, other documentation standardization/ compliance projects) reducing risk of denied claims.
Working knowledge of healthcare law.
Strong written and verbal communication skills.
Ability to work with individuals at all levels of the organization.
Knowledge of long-term acute care industry.
Knowledge of state and federal regulations.
Proficient computer skills.
Bachelor's degree in clinical field required
Registered Nurse preferred
3+ years experience in clinical setting required
1+ years experience in hospital case management required
Depending on a candidate's qualifications, this position may be filled at a different level.
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Job : Other Primary Location : KY-Louisville-Hospital Div Overhead Organization : 4426 - Hospital Div Overhead Shift : Day