Denial Resource Center RN

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level. Job Summary You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health, manage denials and appeals. Your job is to handle claim denials from all insurance companies, addressing various reasons. SALARY The pay range for this position is $40.35 (entry-level qualifications) - $62.52 (highly experienced) The specific rate will depend upon the successful candidate's specific qualifications and prior experience Essential Functions of the Role You receive rejected healthcare claims from financial office or provider. You appeal until resolution following guidelines. Reviewing medical records is important. Verify care levels, admissions, and hospitalizations. Evaluate stay duration and discharge planning. You will contribute to improving processes and protocols by identifying opportunities for enhancement and earnestly participating in their implementation. By closely examining denial trends, you will categorize them based on impacts like diagnosis, type and procedural variations amongst others. You will record denial data and appeal findings in an electronic system. The system helps study denial trends and assess appeal outcomes. Key Success Factors Awareness and knowledge of nursing procedures and patient care standards. Excellent ability in problem-solving and critical thinking. Highly capable of clear communication, both spoken and written. Capability to engage meaningfully with varied groups of people. Ability to carefully observe patients' condition changes and communicate effectively with nursing staff and providers. Belonging Statement We believe that all people should feel welcomed, valued and supported. Qualifications Associate degree. A minimum of (2) two years of relevant work experience is preferred. Applicants should be registered nurses. Clinical Experience: Five (5) or more years of clinical experience preferred with a strong ability to analyze medical records and support medical necessity. As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.