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:
- Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity.
- Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members.
- Maintains and coordinates a timely appeal process or effectuates a correction of billing status.
- Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.
- Location: Tampa or St Petersburg for up to first 6 months and then Remote
- Status: Full time, 40 hours per week
- Schedule: Monday - Friday 7:00 AM - 3:30 PM
- Weekend Requirement: None
- On Call: No
- Required RN License
- Preferred Accredited Case Manager Certification
- Preferred Certified Case Manager
- Required Associate Degree in Nursing and 4 years Utilization Review, Managed Care or Finance OR
- Bachelors Degree in Nursing and 2 years Utilization Review, Managed Care or Finance
- Preferred Masters Degree in Nursing
- Preferred 2 years Case Management
- Preferred 6 months Denials Management
- Preferred 1 year Medicaid/Medicare experience
- Benefits (Health, Dental, Vision)
- Paid time off
- Tuition reimbursement
- 401k match and additional yearly contribution
- Yearly performance appraisals and team award bonus
- Community discounts and more
Equal Opportunity Employer Veterans/Disabled
