Utilization Management Appeals and Denials Nurse - Case Management

Legacy Health

1d • $54 - $81

About The Position

You are the voice, the coordinator and the empathetic advocate of patients facing difficult situations. Your compassion for patients and families with acute and chronic health conditions knows no limits. You are committed to working with healthcare teams to ensure every patient receives the care, comfort and dignity they deserve. If this is how you define your role as a Case Manager, we invite you to consider this opportunity.
The UM Appeals and Denial Nurse, supports, and assists with LHS financial viability through focusing on appeals and denials, billing compliance and cooperative efforts to achieve overall Utilization Management team goals. This position supports the Utilization Management department in maximizing revenue and by providing input regarding appeals and denials. The UM Appeals and Denials Nurse works closely with the Physician Advisor and the appeals management team in writing appeal letters, development and education regarding the revenue cycle process. UM Appeals and Denials Nurse will track financial metrics (example % of appeals won).

Requirements

• Academic degree in nursing (BSN or MSN/MN) required; MSN/MN preferred.
• Five years acute care nursing experience required.
• Current Washington and Oregon RN licensure required.

Nice To Haves

• MSN/MN preferred.
• Five years of healthcare utilization management experience preferred.
• Familiarity with office automation technology preferred.
• Quality assurance, project management, leadership and training skills also preferred.
• Excellent analytical skills to perform analysis and provide recommendations on charge capture and documentation.
• Excellent documentation skills.
• Strong written and verbal communication skills to work directly with all levels of LHS staff, management and physicians, as well as liaison with consultants and vendors.
• Strong organizational and prioritization skills.
• Demonstrated knowledge of billing process including registration, authorization, and insurance denials.
• Demonstrated knowledge of billing/collection rules and regulations.
• Ability to work with credibility and effectiveness with medical and administrative staff.
• Ability to withstand varying job pressures and organize and prioritize related tasks.
• Ability to work efficiently with minimal supervision, exercising independent judgment within stated guidelines.
• Ability to perform the competencies and essential functions of the job as outlined.
• Certification preferred in at least one of the following: Certified Professional in Healthcare Management (CPHM) Health Care Quality and Management (HCQM) Certified Case Manager (CCM) Accredited Case Manager (ACM)

Responsibilities

• supports, and assists with LHS financial viability through focusing on appeals and denials, billing compliance and cooperative efforts to achieve overall Utilization Management team goals.
• supports the Utilization Management department in maximizing revenue and by providing input regarding appeals and denials.
• works closely with the Physician Advisor and the appeals management team in writing appeal letters, development and education regarding the revenue cycle process.
• will track financial metrics (example % of appeals won).

Benefits

• Legacy Health is an equal opportunity employer and prohibits unlawful discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion or creed, citizenship status, sex, sexual orientation, gender identity, pregnancy, age, national origin, disability status, genetic information, veteran status, or any other characteristic protected by law.
• To learn more about our employee benefits click here: www.legacyhealth.org/For-Health-Professionals/careers/benefiting-you

What This Job Offers

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