SCHEDULE: Full-Time; Days (8:00 a.m. - 4:30 p.m.)
Under the direction of the Manager, Clinical Resource Management; the Denial Management Case Manager is responsible for coordination of activities related to management of payment denials. The Denial Management Case Manager serves as a resource for other members of the healthcare team and provides education to team members on issues related to documentation, reimbursement, regulatory agency guidelines and resource use.
Through collaboration, the Denial Management Case Manager assures that denials are appealed in a timely manner, assures vendors involved in the appeal process manages appeals timely, and works with business office to determine correct patient status based on current regulations. Documents denials in denial management systems, collects and maintains data for tracking and reporting for performance improvement.
MINIMUM QUALIFICATIONS REQUIRED:
Education: Registered Nurse with Bachelors Degree in Nursing or related field or case management certification or experience or management education or experience.
Experience: 3 years clinical experience
Jackson Hosptial & Clinic