Denial Prevention Specialist

PFS Denials Nurse Auditor

Remote opportunity available in the following states: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebraska, North Carolina, Oklahoma, Texas, Utah, and Virginia. This position requires a combination of clinical, financial, and regulatory knowledge to reduce financial risk and exposure caused by payer denials for rendered services.

Responsibilities include:

• Completing clinical review of post-claim denials and preparing clinical discussion and appeal letters.
• Consulting with clinical and hospital appeal guidelines and providing appeal direction using payer guidelines.
• Ensuring compliance with all federal, state, and local regulations governing rendered patient services and reimbursement.
• Reviewing and analyzing audit information and providing education to other caregivers to the PFS Denial Management team.
• Identifying and initiating clinical and hospital quality improvement initiatives focused on improving quality indicators and outcomes.
• Collaborating with Revenue Cycle, Admissions, Coding, and other departments to answer clinical questions specific to denial management.
• Researching industry best practices and recommending process improvements to leadership.
• Participating in the review of workflow processes and recommending and participating in the implementation of process improvements.
• Recommending policies which support the direction of the Denials Management Team to improve and reduce denials.

Education: Bachelor's Degree - Graduate of school of nursing (BSN) - Required.

Work Experience: 5 Years - Experience in health care as a registered nurse preferably in revenue cycle. - Required.

Licenses and Certifications: Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Registered Nurse license by the State of Missouri - Required upon hire.

Travel Requirements: None.

About Us: Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place offering high value and quality health care.