At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence.
The Denials Specialist-Utilization Review responsibilities include:
• Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity.
• Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members.
• Maintains and coordinates a timely appeal process or effectuates a correction of billing status.
• Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.
Position details:
• Location: Tampa or St Petersburg for up to first 6 months and then Remote
• Status: Full time, 40 hours per week
• Schedule: Monday - Friday 7:00 AM - 3:30 PM
• Weekend Requirement: None
• On Call: No
Certifications and Licensure:
• Required RN License
• Preferred Accredited Case Manager Certification
• Preferred Certified Case Manager
Education and Experience:
• Required Associate Degree in Nursing and 4 years Utilization Review, Managed Care or Finance OR
• Bachelors Degree in Nursing and 2 years Utilization Review, Managed Care or Finance
• Preferred Masters Degree in Nursing
• Preferred 2 years Case Management
• Preferred 6 months Denials Management
• Preferred 1 year Medicaid/Medicare experience
Benefits:
• Benefits (Health, Dental, Vision)
• Paid time off
• Tuition reimbursement
• 401k match and additional yearly contribution
• Yearly performance appraisals and team award bonus
• Community discounts and more
Equal Opportunity Employer Veterans/Disabled
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