Remote - PFS Denial Nurse Auditor

Mosaic Life Care

140d • $60,382 - $96,616

About The Position

The Denials Nurse Auditor works under the supervision of the manager of PFS Denials. The Denials Nurse Auditor is responsible for completing, appealing, tracking, and reporting clinical denial reviews to determine the appropriate actions for post-billing denials. This Individual will combine clinical, financial, and regulatory knowledge and skill to reduce financial risk and exposure caused by payer denials for rendered services. The Denials Nurse Auditor has highly developed knowledge and skills in areas of: Medical Necessity, Authorizations, Experimental/Investigational denials, payer audits and filing appeals as well as Government and Non-Government payor requirements with Denial Management. This position is employed by Mosaic Life Care.

Requirements

• Bachelor's Degree - Graduate of school of nursing, BSN is required.
• Nursing/RN - Registered Nurse - State Licensure And/Or Compact State Licensure Registered Nurse license by the State of Missouri required.
• 5 Years of experience in health care as a registered nurse, preferably in revenue cycle is required.
• Excellent understanding of financial and health care strategies is required.

Responsibilities

• Completes clinical review of appropriate post-claim denials; prepares clinical discussion and appeal letters for denied accounts.
• Consults clinical and hospital appeal guidelines; provides appeal direction using payer guidelines to appropriate departments via monthly denials meetings.
• Ensures compliance with all federal, state, and local regulations governing rendered patient services and reimbursement.
• Reviews and analyzes specific audit information and provides education to other caregivers both internal and external to the PFS Denial Management team.
• Identifies, and initiates clinical and hospital quality improvement initiatives focused on improving both quality indicators and outcomes.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees