Huron

Nurse Specialist - Clinical Denials and Appeals

Chicago - 550 Van Buren

Sponsorship not specified$34k-$43kDetected 20 days ago

ComplianceExcelHIPAAEpicCernerEHR/EMRResearchLeadershipCommunicationCritical ThinkingMicrosoft OfficeSharePoint

About the role

Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care.
The Clinical Denials and Appeals Nurse Specialist (IP & OP) is responsible for reviewing the claims denied and carrying out the appeals process appropriately and in a timely manner.
This role requires frequent and effective communication via phone, email, and instant messaging with the various engagement teams.

Document all actions taken and follow-up timely as needed related to resolving denials and appeals with third-party payers in a timely manner
Maintains data on the types of claims denied and root causes of denials
Collaborate with management to recommend process changes to address root cause of denials and overall improvement to reduce A/R
Collaborate with team members to continually improve services, and engage in process and quality improvement activities

Clinical Appeals Experience: At least 1 year of clinical appeal writing experience.
2-3 years if ICU experience.
Licensure: Must be Registered Nurse with an active USRN license.
RCM Knowledge: Proficiency in using InterQual or MCG clinical guidelines.
Broad Knowledge of U.S. Government Programs and Insurance Regulations
Associate Degree in Nursing (ADN) or Diploma in Nursing.
Must be Registered Nurse with an active USRN license.
Proficiency in using InterQual or MCG clinical guidelines.
Proficiency with using computer programs for tracking denials and appeals.
Prepares, maintains, assists with, and submits reports as required

Credential/Certification: Case management or clinical appeals or clinical denials certification (ACMA) is preferred.
Software Knowledge: Proficiency with using computer programs for tracking denials and appeals.
Proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, SharePoint)
Ability to pay close attention to details
strong follow-up and follow-through skills

Ability to pay close attention to details; strong follow-up and follow-through skills
Regularly makes complex decisions within the scope of the position, and is comfortable working independently
Requires the use of independent judgment, discretion and decision-making abilities
Demonstrates teamwork and integrity in all work-related activities
Strong analytical and critical thinking skills.
Experience in a matrixed environment
Excellent written and verbal communication skills
The estimated hourly range for this job is $33.65 - $43.27.
The range represents a good faith estimate of the range that Huron reasonably expects to pay for this job at the time of the job posting.
Position Level
United States of America

The actual salary paid to an individual will vary based on multiple factors, including but not limited to specific skills or certifications, years of experience, market changes, and required travel.

Conducts medical necessity reviews, based on denial root cause, and prepares any required clinical documentation summaries to accompany appeals.
Write and submit written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language.

This listing is sourced directly from Huron's careers page and normalized into a canonical job model.