Registered Nurse - Denials and Appeals
Are you a passionate and experienced Registered Nurse looking for a new and exciting opportunity? Prisma Health is seeking a highly motivated individual to join our team as a Registered Nurse - Denials and Appeals. In this role, you will play a vital role in ensuring the accurate and timely review of insurance denials and appeals, advocating for our patients and healthcare providers. If you have a strong background in nursing and are looking for a challenging yet rewarding position, we encourage you to apply.
- Conduct thorough and accurate reviews of insurance denials and appeals.
- Advocate for patients and healthcare providers by communicating and negotiating with insurance companies.
- Utilize clinical knowledge and expertise to identify and resolve issues with denials and appeals.
- Collaborate with other members of the healthcare team to gather necessary information and documentation for appeals.
- Maintain detailed and organized documentation of denials and appeals processes.
- Stay up-to-date on insurance policies and regulations to ensure compliance in appeals.
- Communicate effectively with patients, healthcare providers, and insurance companies regarding denials and appeals.
- Provide education and training to healthcare staff on denial and appeal processes.
- Monitor and track the success rate of appeals and identify areas for improvement.
- Adhere to ethical and legal standards in all aspects of the job.
- Maintain confidentiality of patient information and adhere to HIPAA regulations.
- Participate in meetings and committees related to denials and appeals.
- Continuously seek opportunities to improve processes and efficiency.
- Maintain a positive and professional attitude while handling denials and appeals.
- Ensure timely and accurate reporting of denials and appeals to management.
Current Rn License: A Registered Nurse - Denials And Appeals Must Have A Current And Active Registered Nurse License In The State Where They Will Be Working. This Demonstrates That The Individual Has Met The Education And Competency Requirements To Practice As A Nurse.
Strong Clinical Background: Prisma Health Requires A Registered Nurse - Denials And Appeals To Have A Strong Clinical Background, With Experience In Areas Such As Medical-Surgical, Critical Care, Or Case Management. This Ensures That The Individual Has A Solid Understanding Of Medical Terminology, Procedures, And Treatments.
Knowledge Of Healthcare Regulations: A Qualified Candidate For The Registered Nurse - Denials And Appeals Role Should Have A Strong Understanding Of Federal And State Healthcare Regulations, Including Medicare, Medicaid, And Private Insurance Guidelines. This Knowledge Is Essential In Navigating The Appeals Process For Denied Claims.
Experience In Denials And Appeals: Prisma Health Seeks Candidates With Previous Experience In Handling Denials And Appeals In A Healthcare Setting. This Includes Knowledge Of The Appeals Process, Ability To Analyze Medical Records And Insurance Policies, And Familiarity With Coding And Billing Practices.
Excellent Communication Skills: As A Registered Nurse - Denials And Appeals, Effective Communication Is Vital. The Individual Must Be Able To Communicate Clearly And Professionally, Both Verbally And In Writing, With Patients, Insurance Companies, And Healthcare Providers. This Includes The Ability To Explain Complex Medical Information In A Way That Is Easily Understood By All Parties Involved.
Time Management
Attention to detail
Interpersonal Communication
Clinical documentation
Problem-Solving
Medical coding
Patient Advocacy
Insurance Knowledge
Utilization Review
Denial Management
Appeal Process
Communication
Conflict Resolution
Leadership
Time management
Interpersonal Skills
creativity
Teamwork
Adaptability
Problem-Solving
Decision-making
According to JobzMall, the average salary range for a Registered Nurse - Denials and Appeals in Columbia, SC, USA is $67,000 - $93,000 per year. However, this can vary depending on factors such as experience, education, and location.
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Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. 32,000 team members are dedicated to supporting the health and well-being of people.
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