Denials Recovery Lead

REMOTE position. - in the following states: AL, AZ, AK, GA, FL, IA, IN, IO, KS, LA, MS, MO, MT, NC, OH, OK, SC, SD, TN, TX, UT, VA, WY

Position Highlights:

Acts in a leadership support role to the Denial Team Members. Responsible for assisting the administration and coordination of the denials review and appeals management processes for managed care payers. Assisting with the review, training, management and coordination of recovery / overpayment audits received from entities.  

Responsibilities:

• Team member evaluation of Appeal Process; Assisting with ensuring the denials are appealed timely and efficiently
• Team member support; Assisting with ensuring denial recover and recording in the appropriate systems of all denial related information for effective root cause analysis
• Leadership Support
• New hire evaluations
• Training
• Denial Document Development
• Departmental Liaison

Credentials and Qualifications:

• RN Licensure
• Bachelor’s degree required.
• A minimum of five (5) years’ experience of directly related healthcare experience that includes two (2) years of appeals/denials management in a physician or hospital environment.

* "in lieu of" Bachelor's degree an Associates degree plus an additional two (2) years of directly related healthcare experience, preferably in nursing for a total of seven (7) years may be considered.

Preferred:

• Experience in oncology nursing, utilization review, quality management, and/or recent case management.
• Computer literate, knowledge of financial data analysis, Medicare and Medicaid regulations, third party reimbursement, & charging and coding guidelines.