Clinical Denial Analyst (RN)

Job Overview:

This position is responsible for working assigned denials (such as no authorization, medical necessity, and readmission) from assigned work queues according to policy and established productivity standard. This position will work with third party payors to obtain payment on accounts according to legal and proper collection techniques as well as maintain accounts receivable goals developed by the department. The Coordinator will prepare appeals, reports of denial activity and identify trends for the Denial Analysis Team to make appropriate changes to prevent future denials.

Required: Certifications/Licenses/Experience:

• Active Registered Nurse (RN) in Indiana or other compact licensure state
• Minimum of two (2) years performing utilization review, charge audit, case management or similar functions in an acute care or specialty hospital

Preferred Certification/License/Experience:

• BSN
• Three (3) to five (5) years of clinical experience as a Registered Nurse in an acute care or specialty hospital

Other Key Words: Registered Nurse // HRS // Healthcare Resources // UM // Utilization Management // Case Management

Department: HRS

Hours: Full-time, 40 hours/week