Clinical Denials Coordinator RN, Clinical Denial Unit, Per Diem, Days
Jackson Health•Miami, FL
•Remote
About The Position
The Clinical Denials Coordinator provides backup coverage across the Utilization Review team within Revenue Cycle, including Emergency Department and inpatient Utilization Review and Central Clearance Center workflows as needed. The coordinator reviews denied and potentially denied accounts, identifies denial trends and operational improvement opportunities, and works with affected teams to address process weaknesses and clinical issues that lead to denials. The role also supports payer-focused audits, denial agency reporting and placements, and Utilization leadership projects.
Requirements
- Generally requires 3 to 5 years of related experience.
- A Bachelor of Science degree is required.
- A valid RN credential is preferred.
Nice To Haves
- Past payer experience, specifically with utilization review, denials, audits, and/or appeals.
- At least four years of experience as a registered nurse in ED, ICU, IR, or OR.
- At least two years of experience completing InterQual reviews.
- Clinical Denials Coordinator experience.
- A master's degree and/or certification as an ARNP or Foreign Medical Graduate.
- A Bachelor of Science in Nursing.
Responsibilities
- Audit denied or potentially denied accounts to determine the true reason for denial.
- Collaborate with denial agencies to identify trends and provide reporting to denial committees.
- Work with payors and the JHS managed care department on projects focused on resolving denials and improving recoveries.
- Coordinate denial committee meetings at each facility and ensure reviews and reports are completed on time and presented at each meeting.
- Assist the CBO with monthly reconciliation of placements and recoveries to ensure Siemens and Connance are in balance.
- Coordinate with CFOs and denial committee teams at each facility to ensure net denial targets are met.
- Cross-train and assist with invoice reconciliation as needed.
- Assist with internal and external audit requests relating to denials, as requested by management.
- Perform other related duties as assigned.
