You’ll need
Licensure
✓Licensed to practice nursing as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the State of Florida required.
Certifications
CPC, COC, RHIT, RHIA, or CCS certification preferred.
Education
✓High School Diploma or GED required.
Bachelor’s Degree in Nursing (BSN) preferred.
Qualifications
✓Two (2) to three (3) years of clinical experience as a Registered Nurse (RN) required; OR three (3) to five (5) years of clinical experience as a Licensed Practical Nurse (LPN) required.
Knowledge of or experience related to coding, medical record review, auditing, or insurance processes preferred.
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About the role
Review, track, and manage clinical denials and appeals to support reimbursement optimization and minimize organizational write-offs.
What you’ll do
Review, track, and manageReview, track, and manage clinical denials and appeals to support reimbursement optimization and minimize organizational write-offs
Analyze denied claims fromAnalyze denied claims from a clinical perspective and prepare accurate, well-supported appeals
Collaborate with revenue cycleCollaborate with revenue cycle, finance, compliance, managed care, utilization review, patient access, and clinical departments to resolve denial issues
Research payer policies, contractsResearch payer policies, contracts, EOBs, and reimbursement guidelines to support claim resolution activities
Monitor denial trends andMonitor denial trends and identify opportunities for process improvement and denial prevention