Denials Management RN -Mount Carmel Corporate Service Center
Mount Carmel Health System
February 12, 2018
Job ID: 00054353
Location: Columbus, Ohio
Schedule: Full time
Department: OH1HS_69509_000 Denials Management
Expected Weekly Hours: 40
Shift: Day Shift
At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.
Job Description Details:
The Denials Management RN is responsible for recovery of inpatient and outpatient revenue lost due to third party payment denials and audits. This includes, but is not limited to:
Reviews and maintains an understanding of third party contract requirements for claims, utilization review and appeal processing.
Communicates third party payer contract requirements and trends in denials to key stakeholders including Medical Staff, Case Management, Patient Financial Services, Pre-Planned Services, Patient Access, HIM/Coding and appropriate inpatient and outpatient departments.
Develops and implements strategies for recovering lost revenue through timely submission of appeals, corrected claims and reconsideration's.
Identifies areas of potential lost revenue to payer denials and, utilizing a team approach, implements actions to prevent such denials.
Education: BS degree or equivalent experience in healthcare Licensure / Certification.
Graduate of school of nursing with current, unrestricted license to practice nursing in the state of Ohio.
Experience: Five years in health care with knowledge/experience including managed healthcare, Government payers, federal and state regulations, health care financing principles, third party contracting, case management.
Effective Communication Skills
Discovering opportunities, support and excellence â“ all while making a real difference in patients' lives â“ begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.