RN, Denials Management

Job Summary

Absorbs responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.

Experience Description

• A minimum of 5 years of acute care nursing experience or 5 years nursing with relevant denials/appeals experience is required.
• Prior utilization management, insurance background, and denial management experience is preferred.

Educational Background

• Bachelor's degree is required.
• Professional knowledge of nursing theory and practice at a level normally acquired through completion of a minimum of four years education at an accredited School of Nursing in order to be eligible for licensure as a Registered Nurse is required.

Training

• Previous experience with clinical validation denial review and appeal processes, preferred.
• Knowledge of ICD-10 Coding Guidelines is preferred.

Skills

• Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel.
• Analytical skills necessary to prepare statistical reports and develop solutions to problems.
• Technical writing ability for appeal letters and reports.

Licenses

• Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact).

Compensation, Benefits & Perks

• Pay is expected to be between: $36.38 - $56.39 per hour.
• Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.
• Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:
  • Paid time off
  • Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
  • Academic Partnership with the Medical College of Wisconsin
  • Referral bonuses
  • Retail 403b
  • Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
  • Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available