Northside Hospital Inc.
Location
Sandy Springs, Georgia
The Clinical Denial Specialist processes, tracks, and appeals clinical denials while supporting the development of utilization management data collection methodologies. They analyze data to identify trends and collaborate with medical staff to develop effective action plans.
Candidates must be graduates of an accredited nursing school with strong clinical case management experience. A minimum of three years of experience in utilization management or a related field is required, including expertise in coding, billing, and payer reimbursement methodologies.
Overview Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.
Processes, tracks and appeals clinical denials. Supports and facilitates the design, development and implementation of Utilization Management data collection methodologies and studies in the respective functional areas. Displays and analyzes data to identify trends. Works collaboratively to develop plan of action.
REQUIRED: Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case management experience 2. Three (3) years experience in Utilization Management/Case Management or related field, with specific experience in the following areas: the application of industry prevalent guideline criteria; knowledge of coding, billing, audit and reimbursement payer methodologies and guidelines. Experience in the collection, interpretation, and presentation of data to medical staff members; and, interaction with managed care companies, including appealing denials. Work Hours: 8am- 4:30pm Weekend Requirements: No On-Call Requirements: No