Banner Health RN Denial Management Specialist Remote in Arizona, Arizona
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Primary City/State:
Arizona, Arizona
Department Name:
Denial Recovery-Corp
Work Shift:
Day
Job Category:
Revenue Cycle
Schedule: Monday – Friday 8-hour Day Shifts with flexible start times.
A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities – you belong at Banner Health.
In Centralized Denials Management, we assist our patients by working with insurance payers to get clinical services covered. Our team functions with reasonable goals, a positive team environment, consistent communication from team members and leadership, and a focus on helping you develop and succeed.
You will join a team that allows for inclusion with bi-weekly department meetings, consistent monthly individualized metrics reporting, fun engagement activities every month, and consistent communication for company and department updates. Other perks include the work from home benefits which also will include home equipment. If you are a self-starter, focused, positive, and a team player, we want you to join our team!!
Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you’ll find many options for contributing to our award-winning patient care.
POSITION SUMMARY
This position is responsible for providing support to the organization’s Recovery Audit Contractor (RAC) program by reviewing clinical information and auditing billings to determine appropriateness of charges in accordance with CMS standards. In addition, this position provides oversight for the company’s retrospective denial management process. This position promotes continual efforts to further the understanding of the complexities of federal, state and commercial regulatory coordination and provides leadership assistance to achieve optimal clinical, operational, financial, and satisfaction outcomes across the system as related to reimbursements.
- CORE FUNCTIONS
- Provides clinical expertise and oversight in the determination of the clinical appeals and denial management process resulting in significant savings for the organization. This position is a resource to the company’s RAC team in responding to audit requests and serves to expedite the disposition of claims by reviewing charts and preparing appeals. In addition, this position authorizes the appropriate write off of claims that do not meet criteria for hospitalization. This position serves as primary educator for staff and physicians on regulatory compliance measures and in the use of clinical system criteria.
- Evaluates and intervenes retrospectively for coverage issues, payor outliers, split billing, disallowed charges, incorrect DRG codes, denial and compliance issues.
- Quantifies, analyzes, and monitors industry/Medicare trends in order to reduce denials and improve the financial outcomes for the organization. Makes recommendations for improvements based on these trends.
- Serves as a resource and provides leadership assistance to achieve optimal clinical, operational, financial, and satisfaction outcomes across the system as related to federal, state and commercial reimbursements. Acts as a consultant across the organization to facilities with questions related to proper use of DRG codes.
- Supports change and participates in the development, implementation and evaluation of the goals/objectives and process improvement activities across the organization as related to federal, state and commercial reimbursements.
- Corporate based position with no budgetary responsibility. Internally, this position interacts with physicians, clinicians correct and management across the system. Externally, this position interacts with RAC Auditors and other organizations.
MINIMUM QUALIFICATIONS
Requires Registered Nurse (R.N.) licensure in the state of practice.
Requires experience in federal, state and commercial reimbursements and in reviewing clinical information typically acquired in three years auditing DRG coding and reimbursements. Requires five or more years of clinical nursing and/or related experience. Experience in evaluation techniques, teaching, hospital operations, reimbursement methods, medical staff relations, and the charging/billing process is required. A working knowledge of utilization management and patient services is required. A working knowledge of Medical and third party payor requirements and reimbursement methodologies is required. Highly developed human relation and communication skills are required. Must demonstrate critical thinking, problem-solving, effective communication, and time management skills. Must demonstrate ability to work independently as well as effectively with team members.
Must be proficient in the use of office desktop software programs.
PREFERRED QUALIFICATIONS
BSN preferred.
Additional related education and/or experience preferred.
EOE/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo)
Our organization supports a drug-free work environment.
Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)
EOE/Female/Minority/Disability/Veterans
Banner Health supports a drug-free work environment.
Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability
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