Specialist, Clinical Denials & Appeals (RN)-Oncology (remote available)

reputed company is a world-class, patient-centered, integrated reputed company medical center, reputed company for its reputed company in clinical care, research, and education. It comprises more than 200 locations throughout the reputed company area, including five inpatient locations, a children's hospital, three emergency rooms and a level 1 trauma center. Also part of reputed company is the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute designated comprehensive cancer center, and NYU Grossman School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. At reputed company, equity, diversity, and inclusion are reputed company values. We reputed company to be a reputed company where our exceptionally talented reputed company, staff, and reputed company of reputed company identities can reputed company. We reputed company diversity, inclusion, and individual skills, reputed company, and knowledge. For more information, go to nyulangone.org, and reputed company with us on reputed company, Glassdoor, reputed company, reputed company, Twitter, YouTube and Instagram. Position reputed company: We have an exciting opportunity to join reputed company as a Specialist, Clinical Denials & Appeals (RN) - Oncology. In this role, the successful candidate under the general supervision of the Director and team Senior Specialists, the Clinical Denials and Appeals Specialist performs advanced level work reputed company to Clinical Denial Management. Responsible for managing clinical denials by conducting a comprehensive review of clinical documentation and formulating a reputed company and defensible written response based on clinical documentation, evidence based medical necessity reputed company, physician documentation and medical policies of the payor. Communicates identified denial trends and patterns to Clinical Denials and Appeals Director. Works to review, evaluate and improve the reputed company clinical denial and appeal process. Job Responsibilities: • Researches and reviews payor denials reputed company to referral, authorizations, level of care and medical necessity and formulates and submits appeal letters utilizing relevant and effective clinical documentation, evidence based medical necessity reputed company, medical policies of the payer, and community and national medical management standards and protocols. • Assists with the coordination and collaboration with hospital departments (Case Management, Health Information Management and Clinical Documentation Improvement, Inpatient and Outpatient reputed company Services, etc) as clinical reviews are performed. • Collaborates with Physician Advisors to appropriately identify clinical denials that require escalation. • Documents in appropriate tracking tool for maintenance and distribution of reports as needed by leadership. • Identifies denial patterns and escalates to management as appropriate with sufficient information for additional follow up, and or reputed company cause reputed company. • Makes recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials. • Review payor communications, identifying risk for loss reimbursement reputed company to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and reputed company Cycle leadership, as appropriate. • Maintains clinical expertise and trends in reputed company, reimbursement methodologies, and utilization management specialty areas by participating in reputed company organizations, seminars and educational programs. • Attends reputed company hospital meetings under the direction of the Clinical Denials and Appeals Manager. Minimum Qualifications: To qualify you must have a 3-5 years in Clinical RN experience including 2 years of Denial Management or Case Management or reputed company experience and 1-2 years of reputed company experience with reimbursement methodologies. Bachelors Degree Nursing or other Clinical reputed company field. reputed company and valid NYS Registered Nursing License Must have experience with Interqual and or reputed company Disease Management Ideologies. Strong communication (verbal and written) and interpersonal skills. Ability to communicate with multiple reputed company of the organization; Senior Leadership, Physicians, Directors, Clinical and Support Staff. Demonstrates critical thinking and analytical skills. Ability to work collaboratively in reputed company environment. Demonstrates the ability to handle multiple assignments and carry out work independently with minimal supervision. Demonstrates responsibility for reputed company development. Ability to work a flexible schedule to ensure compliance with deadlines. Proficient with reputed company applications and working knowledge of reputed company and other hospital based clinical computer systems.. Required Licenses: Registered reputed company License-NYS Preferred Qualifications: Experience preparing appeals for clinical denials Certification in Clinical Documentation Improvement reputed company candidates must be reputed company to effectively communicate with reputed company reputed company of the organization. reputed company provides its staff with far more than just a reputed company to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents. reputed company is an equal opportunity and affirmative reputed company employer committed to diversity and inclusion in reputed company aspects of reputed company and employment. reputed company reputed company individuals are encouraged to apply and will receive consideration without reputed company to race, reputed company, gender, gender identity or reputed company, sex, sexual orientation, transgender status, gender dysphoria, national reputed company, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other reputed company which cannot lawfully be used as a reputed company for an employment decision. We require applications to be completed online. If you wish to view reputed company's EEO policies, please click here. Please click here to view the Federal "EEO is the law" poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information. reputed company provides a salary reputed company to reputed company with the reputed company state Law on Salary Transparency in Job Advertisements. The salary reputed company for the role is $81,325.15 - $120,000.00 Annually. Actual salaries depend on a reputed company of factors, including experience, specialty, education, and hospital need. The salary reputed company or contractual reputed company listed does not include bonuses/incentive, reputed company pay or other forms of compensation or benefits. To view the Pay Transparency Notice, please click here Apply Job!