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Denials Specialist - Utilization Review

Baycare

Location: FL-Tampa-St. Joseph%27s Hospital
Type: Full-Time, Non-Remote
Posted on: January 11, 2021
This job is no longer available from the source.
Monday, Tuesday, Wednesday, Thursday, Friday
7:00 AM - 3:30 PM
ACTIVE FULL TIME
Submission for the position: Denials Specialist - Utilization Review - (Job Number: 210364)
https://baycare.taleo.net/careersection/jobdetail.ftl?job=210364&lang=en
Denials Specialist - Utilization Review
The Denials Specialist - Utilization Review 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 Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members, the Denials Specialist - Utilization Review 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. Performs other duties as assigned by department leadership. Required experience includes 4 years Nursing with Associate's degree or 2 years Nursing with Bachelor's degree. Preferred experience includes 1 year Medicaid or Medicare.
Certifications and Licensures Required
RN (Registered Nurse)
Preferred
ACM (Case Management)
Preferred
CCM (Case Manager)
Education Required
Associate's
Nursing
Or
Bachelor's
Nursing
Preferred
Master's
Nursing
Or
Master's
Business
Experience Required
Reference summary for details
Required
2 years
Utilization Review
Or
2 years
Managed Care
Or
2 years
Finance
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
Schedule: Monday, Tuesday, Wednesday, Thursday, Friday Location(s): FL-Tampa-St. Joseph's Hospital Days