Patient Financial Services

Cookeville Regional Medical Center

Clinical Insurance Appeals/Denials Coordinator Apply
PRN
Dayshift
Description:

The Clinical Appeals Nurse reviews denied claims and appeals to the health plan to recover payment for medical necessity, authorization and level of care denials. Review all assigned inpatient denials; obtain additional information as needed to file clinical appeals necessary to resolve payer denial of reimbursement on inpatient, outpatient or observation claims. Communicate clinical denial information to appropriate departments and/or personnel for follow up and educational purposes. Maintenance and upkeep of inpatient denial pools and documents as required

 

  1. EDUCATION:  Tennessee Registered Nurse License

 

  1. EXPERIENCE:  Licensed Registered Nurse with three years hospital experience required.   Experience in clinical specialty area such as OR, ER, or ICU/CCU preferred.  Experience in writing successful appeals preferred.  Knowledge of Medicare billing guidelines required.  Knowledge or use of InterQual criteria and clinical guidelines for admitting patients to the hospital preferred.

 

  1. SKILLS:  Knowledge of general office procedures, proficient computer skills in Microsoft Office required. Must possess excellent writing and communication skills.  Must possess the ability to work well under pressure meeting deadlines, production to handle large volume of claims without diminishing required accuracy. Must be self-sufficient, reliant and able to work well with others. Must be flexible and willing to accept and adapt to constant change due to changes enforced upon providers by insurance carrier changes and regulations and changes in contract negotiations between provider and insurance companies.