RN Spclst-Denials and Appeals - Lisle
Posted on Apr 10, 2019 by AMITA Health
RN Spclst-Denials and Appeals - Total Quality Management 002 - Full-Time,Day - Navistar - Lisle,IL
Why Join AMITA?
AMITA Health ( ) is a joint operating company formed by the Adventist Health System in Altamonte Springs, FL and St. Louis, MO based Ascension.
AMITA Health is the largest health system in Illinois, comprising 19 hospitals and more than 230 sites of care. The health system has 900 providers in its medical groups, more than 26,000 associates and 7,000 physician partners and serves over 4.3 million residents in the greater Chicagoland area.
What You Will Do
As an Associate with AMITA Health, you will have the opportunity to
Serves as the central point person for all commercial and government claim recovery activities providing efficient management of work flow related to commercial denial/appeal and recovery audit activities.
- Uses clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.
- Reviews commercial and government claim denials and audit requests and coordinates attempts to overturn denials by drafting appeals, negotiating with payers, or following up with payer utilization review departments in attempts of obtaining authorizations and claim payment.
- Establishes and maintains positive and cooperative relationships with medical staff and care coordination leaders to ensure ongoing compliance with utilization review guidelines.
- Collaborates with managed care department to code billable items for reimbursement. Collaborates with appropriate staff to secure information for billable items.
- Analyzes and creates reports to capture payer denial trends and volume, to support patient financial services and clinical leaders in the revenue cycle.
- Coordinates projects and audits to improve processes related to revenue cycle, efficiency of charging and billing, and collection efforts.
- May educate case management staff and other departments regarding payer changes and denial/appeal process.
- Required Credential(s):
- Registered Nurse credentialed from the Illinois Board of Nursing obtained prior to hire date or job transfer date.
- Diploma from an accredited school/college of nursing required
- None required.
AMITA Health will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.
Associated topics: ambulatory, asn, care, care unit, hospice, intensive, intensive care, staff nurse, surgical, tcu