Description

American Traveler is hiring an experienced RN for a Clinical Denials Specialist (Case Manager) position requiring Epic proficiency, clinical appeal letter writing experience, and a FL or Compact RN license.

Details

• Hospital-based Case Management/Utilization Review setting within a Revenue Cycle environment
• Primary focus on clinical denial management, including reviewing denied accounts and submitting clinical appeals
• Day shift, 5x8-hour shifts (8:00 AM – 5:00 PM)
• Epic EMR used; experience required
• No telemetry or bedside patient care responsibilities — this is a desk-based denials and appeals role

Requirements

• Active FL or Compact RN license currently in hand
• Current BLS (AHA or ARC) and ACLS required; NIH Stroke Scale certification also required
• Minimum of 2 years of recent, consecutive clinical or case management experience within the past 24 months in a US hospital
• Degree from an accredited nursing school, or from an institution approved by the Florida Board of Nursing (FBON) with 2 years of recent acute care experience
• Clinical appeal letter writing experience required
• Epic EMR experience required, with demonstrated expertise in Revenue Cycle
• Case management experience highly preferred

Additional Information

• Responsible for conducting comprehensive reviews of denied accounts, writing compelling clinical appeal letters, and submitting appeals to payers in a timely manner
• Manages a work queue of accounts receivable and sets follow-up activities based on claim status
• Researches payer denials related to referrals, eligibility, pre-authorization, non-covered expenses, and billing issues
• Remains current on CMS guidelines, payer-specific policies, contracts, and administrative bulletins
• Communicates identified payer denial trends to relevant stakeholders
• Smoke-free facility
• COVID vaccination documentation required — declinations are not accepted
• Local candidates residing within a 60-mile radius of the facility are eligible to apply