APPEALS DENIAL RECOVERY SPLST Administrative & Clerical Support Hours: M-F 7:00a - 3:30p Day Shift - Temporary-Agency Paygrade/Wages/Salary Info: NE N29 - 27.6500 - 34.7000
*****Please note - This is a Temporary Position # Position Highlights: ######Responsible for the administration and coordination of the denials review and appeals management processes that includes denials management, claims recovery, and recovery audit contractor reviews. # The Ideal Candidate Will Have, ## Preferred # Experience in oncology nursing, utilization review, quality management, and/or recent case management Soarian experience. # Responsibilities: # Submit appeals electronically and/or mail. Follow up electronically and/or telephonically with payers for claim and appeal status. # Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted. # Research and prepare responses for payer requests for additional information and documentation. Review of clinical denials including identification of root cause. Resolve clinical denials which include researching and reviewing payer guidelines, writing and submitting appeals with supporting documentation if required. Identifies coding, billing, or reimbursement errors/discrepancies with the denial or aging claim in order to escalate to the denial recovery supervisor. Denied dollars for both contracting and non-contracting insurance companies; and resolution of reimbursement discrepancies. Resolution of denials for medical necessity, utilization review, pre-certification, authorization, and concurrent review to include writing appeals and responsible for conducting and preparing responses. Prepares responses to Medicare recovery audits (RAC) reviews received by Moffitt Cancer Center from any government entity. Claims Recovery Provides Appeals/Denials Consulting and Support. Other duties including special projects as assigned. # # Credentials and Qualifications: ######Bachelor#s Degree required. #####Registered Nursing (RN) license required. ######A minimum of five (5) years healthcare experience required. # ** #in lieu of# a RN license, a Licensed Practical Nursing (LPN) license with an additional two (2) years in a nursing role experience with a total of seven (7) years may be considered. ** #in lieu of# a Bachelor#s degree you must have an Associate#s degree plus an additional two (2) years for a total of#seven (7) years of healthcare experience - preferably in Nursing.