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:
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Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity.
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Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members.
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Maintains and coordinates a timely appeal process or effectuates a correction of billing status.
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Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.
Position details:
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Location: Hybrid - Tampa/St Petersburg
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Status: Full time, 40 hours per week. Exempt
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Schedule: Monday - Friday 7:00 AM - 3:30 PM(can be flexible)
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Weekend Requirement: Occasional
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On Call: No
Certifications and Licensure:
Education and Experience:
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Required 4 years RN experience with ASN and 2 years RN experience with BSN
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Required 2 years Utilization Review OR Care Coordination/Case Management OR Managed Care OR Finance experience
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Preferred Masters Degree in Nursing
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Preferred 6 months Denials Management
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Preferred 1 year Medicaid/Medicare experience
Benefits:
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Benefits (Health, Dental, Vision)
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Paid time off
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Tuition reimbursement
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401k match and additional yearly contribution
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Yearly performance appraisals and team award bonus
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Community discounts and more
Equal Opportunity Employer Veterans/Disabled
Position Denials Specialist RN - Utilization Review
Location Tampa:St Josephs | Clinical | Full Time
Req ID 180585
