RN, Denials Management

Froedtert • Menomonee Falls, WI

20h • $36 - $56 • Remote

About The Position

Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.

Requirements

• Current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact)
• A minimum of 5 years of acute care nursing experience or 5 years nursing with relevant denials/appeals experience
• Bachelor's degree
• Professional knowledge of nursing theory and practice at a level normally acquired through completion of a minimum of four years education at an accredited School of Nursing in order to be eligible for licensure as a Registered Nurse
• Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel
• Analytical skills necessary to prepare statistical reports and develop solutions to problems
• Technical writing ability for appeal letters and reports

Nice To Haves

• Prior utilization management experience
• Prior insurance background
• Prior denial management experience
• Previous experience with clinical validation denial review and appeal processes
• Knowledge of ICD-10 Coding Guidelines

Responsibilities

• Managing inpatient denials for all payers related to medical necessity and clinical validation audits
• Coordinating the appeal process with physicians, coding, third party payers, and third party auditors
• Assisting case managers with utilization review issues
• Providing recommendations for process improvement in utilization review and denial management

Benefits

• Paid time off
• Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
• Academic Partnership with the Medical College of Wisconsin
• Referral bonuses
• Retirement plan - 403b
• Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
• Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

What This Job Offers

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