Denials Specialist - Utilization Review(RN)
At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence.
The Denials Specialist-Utilization Review responsibilities include:
ā¢ Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity.
ā¢ Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members.
ā¢ Maintains and coordinates a timely appeal process or effectuates a correction of billing status.
ā¢ Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.
Position details:
ā¢ Location: Tampa or St Petersburg for up to first 6 months and then Remote
ā¢ Status: Full time, 40 hours per week
ā¢ Schedule: Monday - Friday 7:00 AM - 3:30 PM
ā¢ Weekend Requirement: None
ā¢ On Call: No
Certifications and Licensure:
ā¢ Required RN License
ā¢ Preferred Accredited Case Manager Certification
ā¢ Preferred Certified Case Manager
Education and Experience:
ā¢ Required Associate Degree in Nursing and 4 years Utilization Review, Managed Care or Finance OR
ā¢ Bachelors Degree in Nursing and 2 years Utilization Review, Managed Care or Finance
ā¢ Preferred Masters Degree in Nursing
ā¢ Preferred 2 years Case Management
ā¢ Preferred 6 months Denials Management
ā¢ Preferred 1 year Medicaid/Medicare experience
Benefits:
ā¢ Benefits (Health, Dental, Vision)
ā¢ Paid time off
ā¢ Tuition reimbursement
ā¢ 401k match and additional yearly contribution
ā¢ Yearly performance appraisals and team award bonus
ā¢ Community discounts and more
Equal Opportunity Employer Veterans/Disabled
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The Denials Specialist-Utilization Review responsibilities include:
ā¢ Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity.
ā¢ Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members.
ā¢ Maintains and coordinates a timely appeal process or effectuates a correction of billing status.
ā¢ Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.
Position details:
ā¢ Location: Tampa or St Petersburg for up to first 6 months and then Remote
ā¢ Status: Full time, 40 hours per week
ā¢ Schedule: Monday - Friday 7:00 AM - 3:30 PM
ā¢ Weekend Requirement: None
ā¢ On Call: No
Certifications and Licensure:
ā¢ Required RN License
ā¢ Preferred Accredited Case Manager Certification
ā¢ Preferred Certified Case Manager
Education and Experience:
ā¢ Required Associate Degree in Nursing and 4 years Utilization Review, Managed Care or Finance OR
ā¢ Bachelors Degree in Nursing and 2 years Utilization Review, Managed Care or Finance
ā¢ Preferred Masters Degree in Nursing
ā¢ Preferred 2 years Case Management
ā¢ Preferred 6 months Denials Management
ā¢ Preferred 1 year Medicaid/Medicare experience
Benefits:
ā¢ Benefits (Health, Dental, Vision)
ā¢ Paid time off
ā¢ Tuition reimbursement
ā¢ 401k match and additional yearly contribution
ā¢ Yearly performance appraisals and team award bonus
ā¢ Community discounts and more
Equal Opportunity Employer Veterans/Disabled
Apply Now
Apply Now