Clinical Denial Specialist, RN

Northside Hospital Inc. • Sandy Springs, GA

1d • Onsite

About The Position

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

Requirements

• Graduate of an accredited school of nursing, with strong clinical case management experience
• Three (3) years experience in Utilization Management/Case Management or related field
• Specific experience in the application of industry prevalent guideline criteria
• Knowledge of coding, billing, audit and reimbursement payer methodologies and guidelines
• Experience in the collection, interpretation, and presentation of data to medical staff members
• Experience in interaction with managed care companies, including appealing denials

Responsibilities

• Processes, tracks and appeals clinical denials.
• Supports and facilitates the design, development and implementation of Utilization Management data collection methodologies and studies in the respective functional areas.
• Displays and analyzes data to identify trends.
• Works collaboratively to develop plan of action.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level