Denials Management RN

Overview:

Headquartered in San Francisco Dignity Health is dedicated to providing compassionate high-quality and affordable patient-centered care with special attention to the poor and underserved. For more information please visit our website at www.dignityhealth.org. You can also follow us on Twitter and Facebook.

Responsibilities:

The Denials Management RN is responsible for the following:

• receiving, processing and documenting all concurrent denials for assigned facilities. The RN has an integral role within the revenue cycle by providing clinical expertise in the denials management process.
• performs a root cause analysis of the concurrent denial, formulates and implements a plan for addressing the specific root cause for that denial, identifies gaps in processes that lead to concurrent denials, documents and communicates findings to management. Recommends and provides education in collaboration with their manager.
• follows a standardized approach to managing denials in order to achieve the organizational objectives of financial stewardship and patient advocacy through accurate billing.
• using professional judgment, independent analysis and critical-thinking skills to apply clinical guidelines, policies, and payer knowledge to ensure the best possible financial outcome.
• accountable for demonstrating a strong commitment to promoting quality every day by demonstrating our organizational values of: Compassion, Inclusion, Integrity, Excellence, and Collaboration.

We offer the following benefits to support you and your family:

• Health/Dental/Vision Insurance
• Flexible spending accounts
• Voluntary Protection: Group Accident Critical Illness and Identity Theft
• Adoption Assistance
• Free Premium Membership to Care.com with preloaded credits for children and/or dependent adults
• Employee Assistance Program (EAP) for you and your family
• Paid Time Off (PTO)
• Tuition Assistance for career growth and development
• Retirement Programs
• Wellness Programs

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Qualifications:

Qualifications Required:

• Minimum three (3)years clinical experience as Registered Nurse (RN) required.
• California RN license
• BLS required within 3 months of hiring if located within hospital
• Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used.
• Demonstrate experience in Utilization Management
• Understand how utilization management and case management programs integrate.
• Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost).
• Knowledge of CMS standards and requirements.
• Must have critical thinking and problem-solving skills.
• Collaborate effectively with multiple stakeholders
• Professional communication skills and practical use of good business English, spelling, arithmetic, practices and the ability to communicate effectively using written and verbal skills.
• Proficient computer skills such as Microsoft Excel and Word Google applications, and ability to learn new systems.
• Strong interpersonal skills, with the ability to work as a team player and assist other members of the team where needed.
• Thrive in a fast paced, self-directed environment.
• Proficient in handling multiple priorities and delegating where indicated.
• Highly organized with excellent time management skills and strong attention to detail.

Preferred Qualifications:

• Graduate of an accredited school of nursing [Bachelor's Degree in Nursing (BSN)] or related healthcare field.
• 5 years of RN experience
• Minimum three (3) years utilization management experience
• Denials management experience
• Care Management certification (CCM or ACM) preferred
• Proficient in application of clinical guidelines (MCG/InterQual)

• Knowledge of managed care and payer environment