RN Clinical Appeals
RN Clinical Appeals
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Must have a Michigan RN License
- Understands the revenue cycle and the responsibility and goals of each area and how their role impacts the system.
- Analyzes clinical denial/audit review patient medical records utilizing clinical and regulatory guidelines and applying knowledge of payer requirements to determine why cases are denied and whether an appeal is required.
- Utilizes established clinical criteria and other resources and clinical evidence to develop sound and well-supported appeal arguments.
- Searches for supporting clinical evidence to support appeal arguments when existing resources are unavailable.
- Collaborates with Case Management HIM and/or other team members to determine appropriate responses when necessary.
- Contacts insurance companies to conduct telephonic or electronic appeals if applicable.
- Elevates appeals to the appropriate manager/committee when necessary.
- Provides relevant feedback to applicable departments related to denial root cause analysis and denial prevention
- Ensures compliance with HIPAA regulations to include confidentiality and integrity as required.
- Identifies and refers cases appropriately for Case Management Quality Improvement for education and process improvement.
- Understands and applies payer specific appeal guidelines and elevates cases for payer peer to peer reviews.
- Participates in all educational activities and demonstrates personal responsibility for job performance.
- Maintains a professional image and provides excellent customer service.
- Attends department meetings and education sessions.
- Meets/exceeds performance expectations within required timeframes.
- Practices and adheres to the Code of Conduct philosophy Mission and Values statement.
- Adheres to all Beaumont Health Policies and Procedures.
- Performs other duties as assigned.
- Bachelors degree in Nursing
- 2 years of relevant experience Minimum of two (2) years related experience in health care. Required
- Must be familiar with revenue cycle structure and process. Required
- Background in Case Management. Preferred
- Registered Nurse (RN) - State of Michigan Will consider out of state RN licensure Upon Hire required
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Beaumont Service Center - 26901 Beaumont BlvdDepartment Name
Utilization Management - CH EastEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
7:00 am to 3:30pmDays Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Employment Type
Full-Time
