Denials and Appeals RN
On-site · Omaha, Nebraska, United States
Job Summary
Responsible for the management and communication of clinically-based appeals between Methodist Health System and payers. The role includes promoting positive relations with physicians and patients, reviewing cases for appeal viability, managing documentation and communication to payers, and constructing letters of appeal based on clinical guidelines. Requires collaboration with Physician Advisors, conducting audits, and educating staff about the appeal process. Skills needed include critical thinking, communication, and strong computer skills. A Bachelor's in Nursing and RN license are essential.
Required Qualifications
- Bachelors of Science in Nursing
- Registered Nurse (RN) with current state license
- Five years clinical experience in medical surgical nursing and/or ICU or case management
- Strong communication skills
- Knowledge of healthcare delivery system
Desired Qualifications
- Past experience in an acute care setting as a Denials and Appeals RN preferred.
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