RN Specialist Denials & Appeals

St. Mary's Healthcare • Amsterdam, NY

3d

About The Position

St. Mary’s Healthcare is hiring a full-time RN Specialist Denials & Appeals to support accurate, compliant billing and revenue-cycle processes. The role uses clinical and coding knowledge to review commercial and government claim denials and audit requests, pursue authorization and payment, and coordinate appeals with payers. The specialist works with medical staff, care coordination leaders, the managed care department, and other staff to support compliance, accurate charging, and improved revenue-cycle processes. The position is day shift, 40 hours per week, with a hiring range starting at $81,952 per year. Actual compensation will be determined based on experience and other factors permitted by law.

Requirements

• Registered Nurse credential from the New York Board of Nursing, obtained before the hire date or job transfer date.
• Diploma from an accredited school or college of nursing.
• Ability to organize and establish day-to-day priorities while applying critical thinking.
• Ability to multitask while remaining professional, focused, composed, and positive.
• Excellent customer service skills; integrity, friendliness, and compassion.
• Ability to establish appropriate and effective rapport with others.
• Flexibility and initiative.
• Ability to work in a fast-paced environment.
• Effective critical-thinking and problem-solving skills.
• Proficiency with Microsoft Office products, including Word and Excel.
• Strong organizational and interpersonal skills.
• Ability to take and follow direction positively and appropriately.
• Ability to work both as part of a team and independently.
• Effective and appropriate written and oral communication skills.
• Ability to speak, read, write, and follow instructions in English.

Responsibilities

• Use clinical and coding knowledge to ensure accurate and compliant charge items and identify and resolve billing inconsistencies.
• Review commercial and government claim denials and audit requests.
• Coordinate efforts to overturn denials by drafting appeals, negotiating with payers, and following up with payer utilization review departments to obtain authorizations and claim payment.
• Establish and maintain positive, cooperative relationships with medical staff and care coordination leaders to support ongoing compliance with utilization review guidelines.
• Collaborate with the managed care department to code billable items.
• Collaborate with appropriate staff to secure information for billable items.
• Analyze and create reports on payer denial trends and volume to support patient financial services and clinical leaders in the revenue cycle.
• Coordinate projects and audits to improve revenue-cycle processes, charging and billing efficiency, and collection efforts.
• May educate case management staff and other departments about payer changes and the denial and appeal process.

What This Job Offers

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