RN Coordinator Clinical Denial Recovery/Full Time/Remote – Michigan Residents

Under minimal supervision, this RN specializes in the follow-up of denied and rejected claims from all commercial, contracted and non‐contracted payers, including preparing appeal letters. Working within a centralized department, reviews all denials for medical necessity and appeal ability utilizing clinical judgment and applying appropriate medical necessity criteria. Provides clinical utilization management expertise to give education, formal or informal, and facilitates denial‐management strategies. Serves as a liaison to key customers that include hospital ancillary departments, physicians, and payers.This is a great place to work where you can use your clinical knowledge and experience to support the medical necessity of our patients being admitted to the hospital. You fight for the services that were performed and what should be appropriately paid for. We currently are working remotely; this could change, but as of now it is remote.Education and ExperienceRegistered Nurse with a valid, unrestricted, State of Michigan License required.Minimum 3‐5 years of clinical experience required.Bachelor of Science Nursing required or three years of Denial/Appeal/Utilization Management experience.Knowledge of hospital billing and payer regulations, including criteria for patient status determination, and tools/software used for determination. Additional Information.Organization: Corporate ServicesDepartment: Ascension Payor Audit CDRUShift: Day JobUnion Code: Not Applicable#J-18808-Ljbffr