Clinical Denials Coordinator RN, Clinical Denial Unit

Facility Name: Jackson Health System - Clinical Denial Unit

Facility Address: 1611 NW 12th Ave., Miami, FL 33136

Shift details: Per Diem Days 8:00 am - 4:30 pm, M-F (flexible days, 3 shifts per week) Local Remote only

Why Jackson:

Jackson Health System is a nationally and internationally recognized academic medical system offering world-class care to any person who walks through our doors. For more than 100 years, Jackson has evolved into one of the world's top medical providers for all levels of care, no matter if it's for a routine patient visit or for a lifesaving procedure. With more than 2,000 licensed beds, we are also proud of our role as the primary teaching hospital for the University of Miami Miller School of Medicine.

Summary

Clinical Denials Coordinator is responsible for back up coverage within the entire Utilization Review team within Revenue Cycle which includes: Utilization Review within the Emergency Dept area, Inpatient Utilization Review area, and all workflows within the Central Clearance Center functions as needed. Clinical Denials Coordinators are also responsible for reviewing denied accounts, establishing trends, identifying operational improvement opportunities, working with the impact areas to correct and improve weaknesses within their processes that leads to denials. Audit accounts as needed, and address clinical issues leading to denials. Work with payors on focused audits and coordinate the clinical audits. Work closely with the denial agencies on reporting and placements. Work with Utilization leadership on any assigned team projects.

Responsibilities

• Audit denied or potentially denied accounts to determine true denial reason.
• Collaborate with denial agencies on identifying trends and reporting to denial committees. 
• Work closely with payors and JHS managed care department and manage projects focused on resolving denials and improving recoveries. 
• Coordinate denial committee meetings at each facility and ensure reviews and reports are completed timely and presented at each meeting. 
• Assist the CBO in reconciling placements and recoveries monthly to ensure Siemens and Connance are in balance. 
• Coordinate with CFO's and denial committee teams at each facility to ensure net denial targets are met. 
• Crosstrain and assist with invoice reconciliation as needed. 
• Assist with internal and external audit requests relating to denials as requested by management. 
• Performs other related duties as assigned.

Experience

Generally requires 3 to 5 years of related experience. Preferred past payer experience specifically with utilization review, denials, audits, and/or appeals.

Preferred Experience

• At least four (4) years' experience as a registered nurse in ED, ICU, IR, or OR. 
• Minimum 2 years' experience completing InterQual reviews.
• Clinical Denials Coordinator experience, a plus.

Education

Bachelor's in Science required. Master's degree preferred and/or certification as ARNP or Foreign Medical Graduate.

Preferred Education

Bachelor's in Science in Nursing. 

Credentials

Valid RN is preferred.

Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.