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Utilization Denials Specialist

Baycare

Location: FL-Tampa-St. Joseph%27s Hospital
Type: Full-Time, Non-Remote
Posted on: October 20, 2020
This job is no longer available from the source.
Monday, Tuesday, Wednesday, Thursday, Friday
7:30 AM - 4:00 PM
ACTIVE FULL TIME
Submission for the position: Utilization Denials Specialist - (Job Number: 205990)
https://baycare.taleo.net/careersection/jobdetail.ftl?job=205990&lang=en
Utilization Denials Specialist
The Utilization Denials Specialist is responsible for timely review of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity. Working closely with the Physician Advisor, Registration, Patient Accounts, and Coding department team members, the Utilization Denials Specialist maintains and coordinates a timely appeal process, or effectuates a correction of billing status. Identifies and trends adverse determinations, and shares information with all stakeholders.
Certifications and Licensures Required
RN (Registered Nurse)
Education Required
Associate's
Nursing
Preferred
Bachelor's
Related Field
Experience Required
1 year
Utilization Review
Required
4 years
Nursing
Preferred
2 years
Utilization Review
Preferred
1 year
Managed Care
Preferred
2 years
Case Management
Preferred
6 months
Denials Management
Preferred
1 year
Medicaid
Preferred
1 year
Medicare
Specific Skills Required
Customer service skills
Required
Written and verbal communication skills
Required
Interpersonal skills
Required
Time management skills
Required
Analytical Skills
Required
Knowledge of regulatory standards appropriate to position
Required
Work independently
Required
Computer skills appropriate to position
Required
Organizational skills
Required
Quality Improvement
5105-SOUTH FLORIDA BAPTIST HOSPITAL
FL-Tampa-St. Joseph's Hospital
Equal Opportunity Employer Veterans/Disabled
Schedule: Monday, Tuesday, Wednesday, Thursday, Friday Location(s): FL-Tampa-St. Joseph's Hospital Days