DENIAL RN

Aultman Health Foundation - Canton, OH

Posted: 4/7/2024 - Expires: 7/6/2024

Job ID: 272075566

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Job Description

Req# 28721

Aultman Health Foundation, CANTON, OH

AULTMAN HOSPITAL

Aultman Health Foundation

Full Time, Day Shift, 8am-4:30pm

Position Summary

The Clinical Denials Appeal Nurse is responsible to review charts and write appeals for all clinical and administrative denials as provided by the Denials Team, Denial System and Cerner Utilization Management Module. Facilitates referrals to Physician Advisor and coordinates ongoing levels of medical necessity appeals.

Primary Responsibilities

Ensure first level review is complete for all clinical denials
Facilitates referrals to Physician Advisor and coordinates ongoing levels of clinical appeals.
Coordinates the generation of appeal letters for all payor clinical denials (inpatient) and forwards these onto the Audit Team within the designated timeframe
Utilizes designated Denials Management tracking tool to communicate interventions
Review electronic clinical inpatient denials through the denial system
Participates in strategic initiatives to promote education to areas identified through denials
Functions as a resource to medical staff and hospital staff regarding regulatory and commercial payor requirements
Communicates concerns to other areas within the Hospital as appropriate (Performance Improvement and Medical Records Subcommittee)
Maintain attendance (including tardiness) in accordance with departmental standards
Complete safety evaluation, JCAHO Education, TB Testing, Confidentiality, Information Systems usage and HIPAA/Corporate Compliance notification on an annual basis
Exhibit accepted level of Teamwork and RESPECT
Accept change as needed to meet departmental goals
Prepare or assist with other projects/duties as assigned

Desired Job Qualifications/Skill Sets

UM or Case Management experience is helpful. Coding experience will also be considered.
Effective Communicator
Able to interact with all levels of the hospital team, participating in action planning and educational activities
Well Organized
Working knowledge of case management, utilization management and various software's systems utilized to support these processes.
Understanding of Hospital Revenue Cycle and how Coding, Documentation and Utilization impacts the revenue stream
Ability to work in a cross-functional environment
Solid writing and computer skills (Excel, Word, PowerPoint, and Medipac).
Graduate of approved School of Nursing, BSN, LPN or college course preferred.

Aultman Health Foundation is an Equal Opportunity Employer (EOE) that values and respects the importance of a diverse and inclusive workforce. It is the policy of the company to recruit, hire, train and promote persons in all job titles without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, protected veteran status or disability. We recognize that diversity and inclusion is a driving force in the success of our company. Aultman is an Equal Opportunity Employer that will make reasonable accommodation to enable individuals with disabilities to apply and compete for employment opportunities for which they are qualified. To request an accommodation, please email our Human Resources department at hr@aultman.com , or call 330-363-5415 for further assistance.

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Job Summary

Employment Type:: Full Time Employee
Job type:: Federal Contractor
Skill Based Partner:: No
Education Level:: No school grade completed
Work Days:: Mon, Tue, Wed, Thu, Fri
Job Reference Code: 78917533
Salary: N/A
Licenses / Certifications:: N/A; Applied Math: 4; Graphic Literacy: 5; Workplace Documentation: 4

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DENIAL RN

Aultman Health Foundation - Canton, OH

Job Description

Job Summary