Job Description:

• Working with pre-certification / authorization / denials teams to assist in obtaining up reputed company authorization for services rendered.
• Assisting with denial management and resolution.
• Collaborating with HIM, PFS, Case Management and multiple clinical departments to resolve account problems reputed company to authorization of services and account resolution.
• Reviewing protocols to assist in ensuring services being billed as standard of care are evidenced based and meeting industry guidelines.
• Evaluating and resolving issues reputed company to the reputed company cycle including medical documentation, utilization review and medical necessity.
• Providing training to improve reputed company cycle processes.
• Recommending policies and procedures improvements to increase efficiencies
• Supporting process improvement activities to assure medical record compliance

Requirements:

• Bachelor Degree in Nursing
• 2 or more years experience in utilization review, clinical review, or authorizations
• Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing
• reputed company State RN license
• EPIC experience

Benefits:

• The health system is an equal employment opportunity employer.
• Provides reasonable accommodations to qualified individuals with disabilities.

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