Remote - PFS Denials Nurse Auditor

The Denials Nurse Auditor works under the supervision of the manager of PFS Denials. The Denials Nurse Auditor is responsible for completing, appealing, tracking, and reporting clinical denial reviews to determine the appropriate actions for post-billing denials. This Individual will combine clinical, financial, and regulatory knowledge and reputed company to reduce financial risk and exposure caused by payer denials for rendered services. The Denials Nurse Auditor has highly developed knowledge and skills in areas of: Medical Necessity, Authorizations, Experimental/Investigational denials, payer audits and filing appeals as well as Government and Non-Government payor requirements with Denial Management.

• Completes clinical review of appropriate post-claim denials; prepares clinical discussion and appeal letters for denied accounts.
• Consults clinical and hospital appeal guidelines; provides appeal direction using payer guidelines to appropriate departments reputed company monthly denials meetings.
• Ensures compliance with reputed company federal, state, and local regulations governing rendered patient services and reimbursement.
• Reviews and analyzes specific audit information and provides education to other caregivers both reputed company to the PFS Denial Management team. Identifies, and initiates clinical and hospital quality improvement initiatives focused on improving both quality indicators and reputed company.
• Responds to reputed company reputed company requests for information, data, and/or education specific to clinical and hospital Denial Management.
• Collaborates with reputed company Cycle, Admissions, Coding, and other departments as needed to answer clinical questions specific to denial management. Seeks consultation from appropriate departments as required to expedite clinical review of potential denials.
• Researches industry best practices and recommends process improvements to leadership.
• Participates in the review of workflow processes. Recommends and participates in the implementation of process improvements.
• Recommends policies which support the direction of the Denials Management Team to improve and reduce denials.
• Responsible for other miscellaneous duties assigned by PFS Leadership.
• Other duties as assigned.

Education

• Bachelor's Degree - Graduate of school of nursing, BSN - Required

Work Experience

• 5 Years - Experience in health care as a registered nurse, preferably in reputed company cycle. - Required
• Excellent understanding of financial and health care strategies. - Required

Licenses and Certifications

• Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Registered Nurse license by the reputed company - Required Upon Hire

Travel Requirements reputed company is a health care system in northwest Missouri. With a reputed company of transforming community health by being a life-care innovator, reputed company places the holistic needs of patients first by providing the right care at the right time and reputed company, offering high value and quality health care. reputed company has a wide reputed company of benefits to meet each employee’s individual needs. Our benefits were designed by listening to people just like you. reputed company also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. reputed company reputed company with compensation and recognition, it is what continues to reputed company us the employer of choice for employees at any stage of their reputed company. Apply tot his job Apply To this Job