Clinical Denial Analyst; RN

Job Overview

This position is responsible for working assigned denials (such as no authorization, medical necessity, and readmission) from assigned work queues according to policy and established productivity standard. This position will work with third party payors to obtain payment on accounts according to legal and proper collection techniques as well as maintain accounts receivable goals developed by the department. The Coordinator will prepare appeals, reports of denial activity and identify trends for the Denial Analysis Team to make appropriate changes to prevent future denials.

• Work assigned denials from queues according to policy and productivity standards.
• Collaborate with third-party payors to obtain payment on accounts using compliant collection techniques.
• Maintain accounts receivable goals developed by the department.
• Prepare appeals and reports of denial activity.
• Identify trends in denial activity and recommend changes to prevent future denials via the Denial Analysis Team.

• Active Registered Nurse (RN) in Indiana or other compact licensure state

• BSN
• Three (3) to five (5) years of clinical experience as a Registered Nurse in an acute care or specialty hospital
• Minimum of two (2) years performing utilization review, charge audit, case management or similar functions in an acute care or specialty hospital

Other Key Words: Registered Nurse // HRS // Healthcare Resources // UM // Utilization Management // Case Management

Department: HRS

Hours: Full-time, 40 hours/week

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Bonus:

Potential for a performance-based bonus, subject to eligibility criteria and achievement of defined metrics. Details regarding bonus eligibility and performance goals will be provided during the interview process or upon hire.

Benefits:

We pride ourselves in retaining our top talent by offering work environments that support professional development and personal success. In addition to our robust healthcare and retirement plans, we offer:

• Flexible work schedules – Full time/part time/supplemental – Day/Eve/Night
• Onsite children’s care centers (Infant through Pre-K)
• Tuition reimbursement
• Payactiv-earned wage benefit-work today, get paid tomorrow
• Free access to fitness centers
• Career advancement opportunities

Explore All Benefits:

Divisional/Departmental: Department: HRS