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Clinical Appeals RN-FT-Variable Hours at Centra Health

Lynchburg, Virginia, United States -

Full Time

Start Date

Immediate

Expiry Date

14 Aug, 26

Salary

0.0

Posted On

16 May, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Appeals, Denial Management, Case Management, Medical Terminology, Revenue Cycle Management, Interpersonal Communication, Problem Solving, Clinical Research

Industry

Hospitals and Health Care

Description

The Clinical Appeals RN is responsible for the identification and resolution of technical and/or clinical based denials through appeals. The Appeals Nurse will work with Revenue Cycle staff, case management, clinical departments, practices, and insurance payers (government & commercial) to identify the source of denials and develop processes to eliminate and/or minimize denials and rejections to improve cash flow. The Appeals Nurse works denied and underpaid accounts to obtain full reimbursement for services provided and identify the underlying root cause. The Appeals Nurse will develop recommendations and education plans to prevent future denials and will routinely communicate findings and activities to stakeholders. An Appeals Nurse will serve as the central point person for recovery and audit activities as they relate to clinical denials and overpayments. The Appeals Nurse will be responsible for ensuring clinical appeal deadlines are met to maintain maximum opportunity for reimbursement retention.

Responsibilities

The Clinical Appeals RN identifies and resolves clinical and technical denials to maximize reimbursement and improve cash flow. They collaborate with revenue cycle staff and insurance payers to identify root causes and develop education plans to prevent future denials.