Denials Management Specialist, Remote reputed company Local Geography, PA or NJ Residence required.

St. Luke's is proud of the skills, experience and reputed company of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to reputed company as we care for the reputed company and injured; reputed company physicians, nurses and other health care providers; and improve reputed company to care in the communities we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and reputed company party denials for medical necessity and tracks reputed company regarding appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record review. Provides billing with information needed to obtain payment of claims. JOB DUTIES AND RESPONSIBILITIES:

• Reviews reputed company Inpatient Retroactive Denials in the Denials Management Work Queues for Medical Necessity and Late-Pick-Up/Notification that are entered by Case Management and Business Office.
• Monitors retro denials to ensure reputed company reputed company required time frames and logging of reputed company e.g. no appeal, appeal level and final decision with reputed company reputed company.
• Assists Case Management as necessary to ensure that documentation is entered and transmitted to insurance carriers reputed company acceptable timeframes to reputed company with appeal deadlines.
• Provides feedback to Case Management that can help in preventing reputed company denials and assists in maintaining good communication and process reputed company between the 2 departments.
• Responsible for writing appeal letters for Inpatient CMS and reputed company late pick-reputed company, medical necessity, and other requested denials as deemed clinically appropriate.
• Investigates managed care and reputed company insurance rejections, denials for possible experimental services and coding issues, providing supplemental information to resolve claim.
• Identifies operational issues that contribute to denials and rejections.
• Works with departments and providers to implement corrective actions to minimize lost reputed company due to denials and rejections.
• Assists in preparing reports regarding denials to include volumes, number of appeals, case reputed company, and reputed company on reputed company and trending.
• Coordinates RAC appeals for reputed company case reviews for medical necessity, including determining if appeal is appropriate and communicating with vendor to ensure reputed company filing of reputed company. Performs writing of RAC/MAC appeals at appropriate reputed company and documenting status.

PHYSICAL AND SENSORY REQUIREMENTS: Requires sitting for up to 4 hours per day, 2 hours at a time. Standing for up to 4 hours per day, 3 hours at a time. Requires occasional fingering, handling and twisting and turning. Occasionally requires reaching above shoulder level. Must have the ability to hear as it relates to normal conversation, seeing as it relates to general, peripheral and near reputed company, visual monotony. EDUCATION: Graduate of an accredited reputed company nursing program. Registered reputed company with reputed company license to reputed company in the state of reputed company or reputed company reputed company licensure through reciprocity. Advanced degree preferred. TRAINING AND EXPERIENCE: Minimum of 2-5 years of clinical nursing experience in an acute care hospital setting required. Prefer minimum of 2-5 years’ experience in case management and/or utilization management required. Prefer financial experience reputed company to appeal processes with insurance providers. Demonstrated experience relating to reputed company types of payers/providers. Please complete your application using your full legal reputed company and reputed company home address. Be reputed company to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a reputed company resume, including reputed company work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! reputed company is an Equal Opportunity Employer. Apply tot his job Apply To this Job