Rn Appeal & Denial Specialist - Prn - Days

Departmental Overview

As a part of Documentation Integrity, the Denials team is comprised of highly skilled Registered Nurses and an equally skilled Government audit & Denials analyst who are responsible for review, analysis and appeals for denials at Norman Regional Health System.

Job Summary

• Responsible for performing review, audit and appeals of DRG validation (clinical/coding), medical necessity, readmission and authorizations denials for inpatient and outpatient.
• Registered Nurse Auditor must work with a diverse group of other health care professionals to conduct review and appeal of denials related to all Payor plans.
• Manages and evaluates trends for improvement opportunities.
• Addresses problems, issues or concerns as they relate to accurate documentation.
• Works as part of the team to develop meaningful information for the hospital to improve operational performance and cash collections.
• Nurse auditor must have knowledge of government/OK State policies. 
• Auditor should be able to work well individually and as part of a team.
• Assists with chart and defense audits with outside payers accurately documenting findings and non-findings, and providing clinical/policy/regulatory support for determination.

Qualifications

Education

• Requires BSN, or A.D.N.

Experience

• Minimum of five years’ experience in acute patient care setting.
• Minimum of two years’ experience in Clinical Documentation or Appeal/Denial Management.

(Above requirements can be met by the equivalent combination of education and experience).

 

Licensure/Certification

• Current OK RN license or active Multistate RN license required.

Compensation

• $26.77-$43.71/hr depending on previous work experience.

Schedule
Monday-Friday dayshift up to 24 hours per week
Work Shift
Day
Position Type
PRN