DanburyRecruiter Since 2001
the smart solution for Danbury jobs

Corporate Denials & Appeals RN

Company: Nuvance Health
Location: Danbury
Posted on: April 5, 2021

Job Description:

Overview
Nuvance Health has a network of convenient hospital and outpatient locations - Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center, and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations. For more information about Nuvance Health, visit .
Corporate Billing Compliance, Denials & Appeals RN Department: Case Management Location: Danbury, CT
Purpose: The Billing Compliance, Denials & Appeals RN is responsible for the systemwide retroactive medical necessity review of medical services provided. The position is integral in the revenue cycle on a system level and exists to partner with Case Management and the System Business Office to support billing compliance for Medicare one-day stay claims and to overturn claim denials through the appeal process. The RN will conduct the federally mandated review of all Medicare short-stay claims prior to billing for the entire Health Quest system. The RN will review and respond to all government payer (Medicare and Medicaid) denials and is responsible for trending and reporting government payment audits to the appropriate oversight committee (Medical Executive Committee, Utilization Management Committee, Quality and Performance Improvement Committee, etc.). This position is key in denial prevention through auditing, education and training, compliance monitoring, and process improvement of revenue cycle functions. This role is also responsible for the assessment, plan, coordination, and evaluation of initial and ongoing denials. The RN obtains information on all denials occurring as related to observation and inpatient stays. He/she identifies trends and responds to the trends by recommending changes in practice and or documentation of the providers to promote a reduction in the denials trends.
Essential Responsibilities

  • Concurrently reviews all medical and surgical denials and provides a recommendation for responding or not responding to the denials.
  • Reviews denial data on a weekly basis to understand accounts that have been written off to a denial or are currently in open billing denial status. Increase accurate claim submission by reviewing, researching, resolving, and trending claim issues, and assisting in training and education.
  • Works all denied cases to assess medical necessity and to verify that appropriate billing practice guidelines are adhered to. Works all inpatient denials for discharged patients from all payers including government payers, managed care, and commercial payers. Discusses any cases with Medical Director(s) or Physician Advisor (s) as needed to establish the level of care and/or plan for appeal.
  • Coordinates the submission of appeals to third-party payers within allotted timeframes to prevent fiscal penalties. Appeals payment of services denied by Medicare, Medicaid, and Commercial payers by writing and presenting appeals to Insurance Reviewers, Hearing Officers, and Administrative Law judges.
  • Works with professional providers and hospital departments to bill under the correct admission category and educate on required documentation for the prevention of denials.
  • Prioritizes assignments to avoid financial risk.
  • Serves as a financial resource to the team.
  • Provides follow-up processing for the Livanta IPRO Medicare Appeal process only for the instances when a patient has initiated a discharge appeal and has then agreed to the discharge and left the hospital before the appeal determination has been made.
  • Coordinates activities and strategies with the Care Management Department, Patient Access, Billing, Managed Care, and Physician Advisors.
    QualificationsEducation and Experience Requirements:
    • Associates Degree in Nursing
    • 3 years experience in acute care Nursing
    • 3 years experience as a Utilization Review Nurse in a payer or acute care setting
    • PREFER: Bachelor's Degree or Master's Degree in Nursing
    • PREFER: At least 3 years of experience in revenue cycle management, preferably in a hospital provider environment
    • PREFER: Experience in billing cycle language and managed care contract language
    • PREFER: Experience with Medicare/Commercial appeals/denials
      Minimum Knowledge, Skills, And Abilities Requirements
      • Must be knowledgeable about financial impacts of payor coverage associated with the organization and the patient
      • Must be self-starter, highly motivated worker
      • Ability to form positive, collaborative relationships with hospital staff, providers, patients, and families
      • Must have analytical abilities to assist in obtaining solutions to problems
      • Must be able to work independently, manage stress, and prioritize work
      • Must be able to manage multiple competing priorities and maintain a calm demeanor in a stressful environment
      • Ability to interact with all members of the surgical team and administrative staff in a professional and courteous manner.
      • Knowledge of InterQual and MCG as well as CMS Last Covered Day or LCD / Non - Covered Day or NCD documentation
        License, Registration, Or Certification RequirementsCurrent NYS Registered Nurse (RN)

Keywords: Nuvance Health, Danbury , Corporate Denials & Appeals RN, Healthcare , Danbury, Connecticut

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


Clinical Laboratory QA/QC Coordinator
Description: Generalist opening in White Plains, New York. This and other medical lab technician jobs brought to you by AlliedHealthJobCafe.com REF:CO173Clinical Laboratory QA/QC Coordinator Full time and permanent (more...)
Company: KA Recruiting Inc.
Location: White Plains
Posted on: 04/14/2021

Physician Assistant Cardiac Surgery
Description: Cardiology-Interventional opening in White Plains, New York. This and other physician assistant jobs brought to you by DocCafe.com JOB TITLE: Physician Assistant PA Cardiac Surgery - ICU / Telemetry (more...)
Company: White Plains Hospital
Location: White Plains
Posted on: 04/14/2021

Histology Technologist
Description: Tissue Fixation/Identification/Processing opening in White Plains, New York. This and other histotechnician jobs brought to you by AlliedHealthJobCafe.com Job Functions, Duties, Responsibilities and Position (more...)
Company: KA Recruiting Inc.
Location: White Plains
Posted on: 04/14/2021


Acute Care Nurse Practitioner/ACNP, Advance Practice Registered Nurse/APRN or Physician Assistant/PA
Description: Family Practice/Primary Care opening in White Plains, New York. This and other physician assistant jobs brought to you by DocCafe.com Leading Medical Group in Connecticut looking
Company: NOW Healthcare Recruiting
Location: White Plains
Posted on: 04/14/2021

Nocturnist job ; Closed ICU; flexible schedule- in Westchester (25 miles from Manhattan)
Description: Internal Medicine opening in White Plains, New York. This and other physician jobs brought to you by DocCafe.com White Plains Hospital, a 292 bed, leading award winning hospital, located in Westchester, (more...)
Company: White Plains Hospital
Location: White Plains
Posted on: 04/14/2021

IHC Histotechnician
Description: Tissue Fixation/Identification/Processing opening in White Plains, New York. This and other histotechnician jobs brought to you by AlliedHealthJobCafe.com Full-time IHC Technologist needed Reference (more...)
Company: KA Recruiting Inc.
Location: White Plains
Posted on: 04/14/2021

Pulmonology position in NY
Description: Pulmonology opening in White Plains, New York. This and other physician jobs brought to you by DocCafe.com Pulmonary Medicine opening near New York City Located in White Plains,
Company: Archway Physician Recruitment
Location: White Plains
Posted on: 04/14/2021

Physician Assistant
Description: Cardiology-Interventional opening in White Plains, New York. This and other physician assistant jobs brought to you by DocCafe.com JOB TITLE: Physician Assistant PA ndash Lead/ Chief Cardiac SurgeryJOB (more...)
Company: White Plains Hospital
Location: White Plains
Posted on: 04/14/2021

Physical Therapist Travel Assignments
Description: Nationwide Travel Locum Therapist Jobs - Physical Therapist Are you looking for a new therapist job Would you like to spend the season somewhere you've never been Hospitals, Clinics, Outpatient and (more...)
Company: HCEN Travel Solutions
Location: White Plains
Posted on: 04/14/2021

Physician Assistant (PA) NIGHTS Cardiac - ICU / Telemetry, Westchester, 25 miles from Manhattan
Description: JOB TITLE: Physician Assistant PA - ICU / Telemetry for cardiac services department JOB TYPE: FULL TIME SCHEDULE: 3 x12.5 hours varied shifts, days NO CALLS The successful candidate will have at (more...)
Company: White Plains Hospital
Location: White Plains
Posted on: 04/14/2021

Log In or Create An Account

Get the latest Connecticut jobs by following @recnetCT on Twitter!

Danbury RSS job feeds