10 days old

Claims Denial Nurse

Kindred Healthcare
Louisville, KY 40202

Description

We are recruiting for a Claims Denial Nurse to join our Hospital Division in Louisville, KY.

Please note:  This position will support clients in the Central Time Zone.
 
Summary:
 
Responsible for denial assessment, analysis of clinical documentation, and formulation of appeal letter when medical necessity and non-clinical denials are received from third party payers (government and non-government).   Writes claim appeal letters according to evidence in the medical record and defined appeal process.  Ensure timely submission of appeal letters.
 
Essential Functions:
  • Excellent writing skills.
  • Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
  • Knowledge of accreditation standards and compliance requirements.
  • Knowledge of government and non-government payer practices, regulations, standards and reimbursement processes.
  • Knowledge of established national medical necessity guidelines (InterQual level of care LTAC criteria, Milliman Care Guidelines for LTAC).
  • Compose appeal letters for the Hospital Division, including Inpatient Rehabilitation Facilities (IRFs).
  • Ability to review medical, financial and admission criteria documentation to prepare well-written appeal letters.
  • Ability to communicate whether denial is substantiated or viable after review of medical, financial, and admission documentation.
  • Regularly review periodicals, web sites and other media for changes in current guidelines.
  • Provide educational material relative to types of claims and errors identified during review of medical and financial documentation.
  • Recommend projects that promote documentation improvement (i.e. form, ProTouch, other documentation standardization/ compliance projects) reducing risk of denied claims. 

Knowledge/Skills/Abilities:

  • Working knowledge of healthcare law.
  • Strong written and verbal communication skills.
  • Ability to work with individuals at all levels of the organization.
  • Knowledge of long-term acute care industry.
  • Knowledge of state and federal regulations.
  • Proficient computer skills.



Qualifications

Education:

  • Bachelor's degree in clinical field required

Licenses/Certification:

  • Registered Nurse preferred

Experience:

  • 3+ years experience in clinical setting required
  • 1+ years experience in hospital case management required
Depending on a candidates qualifications, this position may be filled at a different level. 
 
If you are a current Kindred/RehabCare employee Click Here.
","educationRequirements":"Kentucky-Louisville-Hospital Div Overhead","identifier":"372753","industry":"10760","qualifications":"

Education:

  • Bachelor's degree in clinical field required

Licenses/Certification:

  • Registered Nurse preferred

Experience:

  • 3+ years experience in clinical setting required
  • 1+ years experience in hospital case management required
Depending on a candidates qualifications, this position may be filled at a different level. 
 
If you are a current Kindred/RehabCare employee Click Here.

Categories

Posted: 2019-11-26 Expires: 2020-01-05

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Claims Denial Nurse

Kindred Healthcare
Louisville, KY 40202

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