Appeals-Denial Specialist

Job ID: 248081Appeals-Denial SpecialistHalethorpe, MarylandRegular / Day
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Additional Job Information
Title: Appeals-Denial Specialist
City, State: Halethorpe,MD
Location: Lansdowne Station-Halethorpe
Department: Patient Accounting 001
Additional Job Details: FT,Day, 80 hours,Weekly
About Us
For more than 150 years, Saint Agnes Hospital, part of Ascension, has been dedicated to the art of healing by providing exceptional care to the greater Baltimore area. Built on a strong foundation of excellent medical care and compassion, Saint Agnes and the physicians who practice here are committed to providing the best care for our patients for many years to come.
Job Description
Job Summary:
Appeals-Denial Specialist, provides health care services regarding admissions, case management, discharge planning and utilization review.
Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases.
Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
Assesses and coordinates discharge planning needs with healthcare team members.
Prepares statistical analysis and utilization review reports as necessary.
Other duties as assigned.
Supports the efforts of the Care Management Department through the avoidance, investigation, and appeal of denials of days of care and/or patient care services.
Interacts with the Physician Advisor, Care Management staff, Admitting and Accounts Receivable staff on a daily basis and assists with trouble shooting issues on an ongoing basis. Networks with insurers to resolve those denial issues that can be managed successfully without appeal.
Serves as a resource for the care managers, insurance carriers, admitting and accounts receivable. Provides ongoing education to ancillary departments in an effort to maximize denial management and the overturn of denied days. Creates and updates booklets that are specialty specific and guide the care managers in appropriate documentation to ensure approval of stay days and services.
Required Credential(s):
Licensed Registered Nurse credentialed from the Maryland Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date.
Require: Graduate of an accredited school of professional nursing at date of hire Preferred: Bachelor of Science in Nursing degree at date of hire
Work Experience:
Required: Five years experience in the clinical setting, preferably med/surg and/or adult critical care with two years utilization review experience at date of hire. Preferred: Prior experience in denials and appeals, and knowledge of insurance regulations/contracts, is strongly suggested. Knowledge of Interqual/Milliman criteria. Prior work as a care manager/utilization review nurse and knowledge regarding Medicaid and the 3808 process is a plus at date of hire.
How To Apply
Welcome to the Careers Home Page. On-line applications must be submitted for employment consideration.
Associate job applications/transfer requests must be completed through the Associate Health Portal in order to be processed.
To apply for this job, please go and log-in to
http://portal.ascensionhealth.org and proceed to the Associate Self Service section. Click on the Job Opportunities link and search for your next career.
EXTERNAL APPLICANTS please click the ""Apply Now"" button.
If you have a disability and/or require assistance completing the online application, please contact Ascension candidate care at 855-778-6037.
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For questions or assistance with completing the online application, please contact Ascension candidate care at 855-778-6037.
Equal Employment Opportunity
We are an Equal Opportunity Employer.
As an equal opportunity employer, Saint Agnes Hospital does not discriminate on the basis of race, color, national origin, sex, sexual orientation, religion, age, mental or physical disability, marital status, veterans status, military service, or any other legally protected status.
Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

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