Registered Nurse - Clinical Denials Appeals

Are you a compassionate and driven Registered Nurse looking for a rewarding career opportunity? Children's Hospital Colorado is seeking a skilled and experienced RN to join our team as a Clinical Denials Appeals Nurse. In this role, you will play a crucial role in ensuring our patients receive the best possible care by advocating for their medical needs and appealing any denials of coverage. We are looking for a dedicated and detail-oriented individual with a strong background in clinical denials management and appeals. If you are passionate about making a positive impact on the lives of children and families, we would love to hear from you. Join us at Children's Hospital Colorado and be a part of our mission to improve the health and well-being of our community.

1. Review and evaluate medical records to identify potential denials of coverage for patients.
2. Collaborate with healthcare providers and insurance companies to gather and organize necessary information for appeal submissions.
3. Analyze and interpret insurance policies and contracts to determine appropriate course of action for appeals.
4. Develop and maintain strong relationships with healthcare providers and insurance companies to effectively advocate for patients' medical needs.
5. Utilize clinical knowledge and expertise to identify and address discrepancies or errors in denied claims.
6. Prepare and submit timely and accurate appeals, including all necessary supporting documentation and evidence.
7. Maintain accurate and detailed records of all appeals and outcomes for reporting and tracking purposes.
8. Stay current on industry trends and changes in insurance policies and regulations related to clinical denials and appeals.
9. Provide education and training to healthcare providers and staff on best practices for avoiding denials and successfully appealing denied claims.
10. Collaborate with interdisciplinary teams to identify and implement strategies for reducing clinical denials.
11. Maintain strict confidentiality and adhere to HIPAA regulations in all aspects of job duties.
12. Display compassion, empathy, and understanding when communicating with patients and families during the appeal process.
13. Advocate for the mission and values of Children's Hospital Colorado through exceptional service and patient care.
14. Participate in departmental meetings and trainings to stay informed and contribute to the continuous improvement of the appeals process.
15. Maintain a positive and professional attitude while working independently and as part of a team in a fast-paced and high-stress environment.

According to JobzMall, the average salary range for a Registered Nurse - Clinical Denials Appeals in Denver, CO, USA is between $74,000 and $92,000 per year. Factors such as years of experience, education level, and specific job duties may affect the salary range.

Children's Hospital Colorado is a academic pediatric acute care children's hospital located in the Anschutz Medical Campus near the interchange of I-225 and Colfax Avenue in Aurora, Colorado. The hospital has 434 pediatric beds at its main campus in Aurora.