[Hiring] Clinical Denials Coordinator @Jackson Health

Role Description

The Clinical Denials Coordinator is responsible for backup coverage within the entire Utilization Review team within Revenue Cycle, which includes:

• Utilization Review within the Emergency Department area
• Inpatient Utilization Review area
• All workflows within the Central Clearance Center functions as needed

Responsibilities include:

• Auditing denied or potentially denied accounts to determine true denial reason
• Collaborating with denial agencies on identifying trends and reporting to denial committees
• Working closely with payors and JHS managed care department to manage projects focused on resolving denials and improving recoveries
• Coordinating denial committee meetings at each facility and ensuring reviews and reports are completed timely and presented at each meeting
• Assisting the CBO in reconciling placements and recoveries monthly to ensure Siemens and Connance are in balance
• Coordinating with CFOs and denial committee teams at each facility to ensure net denial targets are met
• Crosstraining and assisting with invoice reconciliation as needed
• Assisting with internal and external audit requests relating to denials as requested by management
• Performing other related duties as assigned

Qualifications

• Generally requires 3 to 5 years of related experience
• Preferred past payer experience specifically with utilization review, denials, audits, and/or appeals
• At least four (4) years' experience as a registered nurse in ED, ICU, IR, or OR
• Minimum 2 years' experience completing InterQual reviews
• Clinical Denials Coordinator experience, a plus

Requirements

• Bachelor's in Science required
• Master's degree preferred and/or certification as ARNP or Foreign Medical Graduate
• Bachelor's in Science in Nursing preferred
• Valid RN is preferred

Company Description

Jackson Health System is a nationally and internationally recognized academic medical system offering world-class care to any person who walks through our doors. For more than 100 years, Jackson has evolved into one of the world's top medical providers for all levels of care, no matter if it's for a routine patient visit or for a lifesaving procedure. With more than 2,000 licensed beds, we are also proud of our role as the primary teaching hospital for the University of Miami Miller School of Medicine.