Registered Nurse (RN), Denials and Appeals Coordinator, Full Time

Hialeah Hospital • Hialeah, FL

3d

About The Position

The Denials and Appeals Nurse Coordinator involve a variety of responsibilities, including managing denials and appeals for denied claims, ensuring timely resolution, and minimizing financial losses for the organization.

Requirements

• Current State of Florida Registered Nurse License
• A minimum of 3 years of experience in case management or any other review cycle area.

Responsibilities

• Handling prior authorizations, concurrent reviews, and retrospective reviews and submitting clinical documentation to the patient's primary health insurance to show medical necessity.
• Tracking insurance authorization requests through Availity, Oscar, and UHC portals and also via email and fax for insurances that are not available online to make sure approvals are received on time.
• Preparing appeals when services are denied and coordinating with providers for peer-to-peer reviews and reconsideration authorizations for In-House patients.
• Working with case management, providers, and admissions teams to prevent denials and keep documentation accurate.
• Watching important measures like approval rates, denial trends, and turnaround times, then sharing results with leadership.
• Overseeing the department's daily workflow and tracking important metrics along with the director of case management.
• Coordinating complex patient care across all units.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed