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Clinical Denial Specialist

Rehab Administration

 

Address   Franciscan Health
    24 Joliet Street
    Dyer, IN 46311

Hours  Days

Calendar  Part-Time Benefit eligible

Education Bachelor's Required

WHAT WE NEED

A persistent person who can find the answers

WHO WE ARE LOOKING FOR

High quality health care is both a calling and a business. And the business side dictates reviewing clinically denied cases, determining if appeals can be made, and providing follow-up. Bottom line: this job is important for back-end operations. Think you’re up for the job?

Are you timely and accurate? Are you detail-oriented? Do you love knowing that you’re an integral part of the team? We’ve got a great place to put your skills to work.

WHAT YOU WILL DO
  • Develop reports.
  • Review governmental contractor’s response.
  • Identify underlying root causes for potential denials and works closely with departments and Clinical Documentation Integrity to reduce denials.
  • Write and ensure all appeals are filed in a prompt and timely manner for Medicare, Medicaid, Managed, and Commercials Payor.
  • Audit medical documentation for adherence to insurance and CMS guidelines relating to inpatient/ observation services, or other denial issues.
  • Knowledge of inpatient criteria to establish medical necessity letters.
WHAT IT TAKES TO SUCCEED
  • Prior experience in nursing or case management and/or denials.  
  • Knowledge of common diagnostic procedures.
  • Work independently with minimal supervision.
  • Critically evaluate and analyze information in written materials.
  • Knowledge of Managed Care requirements under the Medicare/Medicaid and other third party payor programs.
  • Solve problems by analyzing information and using logic to address issues and problems.
  • Analyze and synthesize complex quantitative information.
  • Spreadsheet development and management.
  • Interpret test results and formulate reports.
  • Effectively communicate verbally and in writing. 


WHAT WE'RE LOOKING FOR

 

3-5 Years Experience

License(s): Registered Nurse

Certification(s):

Travel: Up to 20%

 

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

NURSING SERVICES ​​​​


Nearest Major Market: Gary
Nearest Secondary Market: Chicago