Education: Minimum of an associate’s degree in nursing is required; BSN is preferred. Requires a current RN license for the state of Arkansas. Must have two (2) years of relevant experience.
Training and Experience: Minimum of two (2) years’ recent experience in hospital case management and/or hospital revenue cycle required. Three (3) years of experience in a healthcare revenue cycle or clinic operations role with one (1) of those years being in a role which included claim-related appeal writing is preferred. Should have experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms. Should have knowledge of Medicare, Medicaid and third-party reimbursement methodologies and of local, state and federal healthcare regulations.
Job Knowledge: Must have the ability to make good decisions in demanding situations, focus on continuous process improvement, have effective communication skills, and the ability to listen empathically. Should possess extensive writing capabilities and the ability to organize details logically and accurately. Must have the ability to manage multiple tasks easily and efficiently, work independently, and be results oriented. Must have the ability to multitask and use various computer applications. Basic math skills and knowledge of general accounting principles are necessary.
Safety Sensitive: NO
In the interest of protecting the health and safety of all patients, associates, and guests, Unity Health has classified some positions as “safety sensitive.” A “safety sensitive” position is any job position in which impaired performance could result in harm to the health and/or safety of self or others. Any associate that is actively engaged in the use of medical marijuana, even if in possession of a valid medical marijuana card, will be excluded from employment in a “safety sensitive” position.
DESCRIPTION:
The Clinical Denial Audit/Analyst RN performs advanced level work related to clinical denial management. The individual is responsible for managing claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, etc. Will assist with the tracking notification and following of denials in Compliance 360. The Clinical Denial Audit/Analyst RN writes and submits professional appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language and coding guidelines. Appeals are submitted timely and tracked through until final outcome. Will also handle audit-related / compliance responsibilities and other administrative duties as required. Works independently to plan, schedule, and organize activities that directly impact hospital and physician reimbursement and assist in creating and maintaining documentation of key processes.
