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
• *Position** Denials Specialist - Utilization Review(RN)
• *Location** St Petersburg:Carillon | Clinical | Full Time
• *Req ID** 141563
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