Rn Denials Specialist Jobs

To be eligible, you must be a non-BILH employee or a previous eligible employee who returns to BILH after 1 year.

Previous employees returning within 1-Year are eligible for a retention bonus.

Employee must be in good standing to receive the bonus at the time of payment.

All bonuses are subject to applicable taxes. This program is subject to change at any point

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.

If candidate does not have EPIC experience, state what electronic medical record system they are using for working current denials.

Reviews all patient complaints and works to ensure a positive customer service experience by fully answering patient queries

Reviews denial reasons, validates accurate coding, and initiates appeals process for claims to ensure prompt and accurate payment.

Works to understand denial reason using provided information from payer

Collaborates with coding team, as needed, to ensure understanding of initial code selection and if updates are required

Researches payer-specific coverage policies to determine if an appeal is warranted

Experience in health care sales and/or management with P&L responsibility

3-5 years sales or management experience preferably in a Hospice or Healthcare environment

Bachelors degree in business administration or related field or equivalent experience and knowledge

Employee must meet minimum requirements to be eligible for benefits

Knowledge of hospice operations, state and federal regulations and compliance

Strong regulatory affairs and governance requirements for healthcare

Experience in health care sales and/or management with P&L responsibility

3-5 years sales or management experience preferably in a Hospice or Healthcare environment

Bachelors degree in business administration or related field or equivalent experience and knowledge

Employee must meet minimum requirements to be eligible for benefits

Knowledge of hospice operations, state and federal regulations and compliance

Strong regulatory affairs and governance requirements for healthcare

Experience in health care sales and/or management with P&L responsibility

3-5 years sales or management experience preferably in a Hospice or Healthcare environment

Bachelors degree in business administration or related field or equivalent experience and knowledge

Employee must meet minimum requirements to be eligible for benefits

Knowledge of hospice operations, state and federal regulations and compliance

Strong regulatory affairs and governance requirements for healthcare

Requires advanced knowledge in coding, auditing, and documentation guidelines. Experience in Radiation/Medical Oncology (Specialty)

Must have Oncology and Radiation experience

Coordinating with operations team to identify additional quality review requirements and provide necessary reviews accordingly.

New sites transition training and eligibility qualification.

5 years of experience as a coder and a minimum of 3 years of experience in quality analysis/chart reviews preferred.

Proficient knowledge of medical terminology, ICD-9 and CPT coding.

Two years experience in Obstetrics.

Prior Maternal Child Health Experience preferred.

Registered Nurse, CA RN license

Case Management or Utilization Review experiences strongly preferred

Knowledge of patient insurance process and requirements preferred

2+ years of experience in an acute care hospital direct patient care setting required

Identifying the root cause for clinical claim denial

Reviewing medical records against nationally recognized clinical criteria guidelines (Interqual, MCG, NCD/LCD,DCA, etc.)

Using clinical decision making to determine the appropriate actions needed to recover or defend revenue