Hospital Claims Denials Management Registered Nurse

Managed Care Staffers

Job Description

Temporary F/T Hospital Claims Denials Management Registered Nurse Needed in Oak Park, IL

Our client, a hospital located in Oak Park, IL has an immediate staffing need for an experienced temporary full-time Hospital Claims Denials Management Nurse. This is a temporary full-time position working Monday-Friday from (8:00am to 5:00pm). This is an on-site hospital-based position located in Oak Park. A Covid-19 Vaccination is required. Must be reliable and immediately available for employment.

Job Responsibilities

  • Utilize your clinical expertise & insurance knowledge to appeal hospital claims.
  • Reviewing clinical data to determine claim payment based on hospital policies and (NCQA) guidelines as well as medical necessity.
  • Review patient charts, claims, patient accounts, medical records and EOBs to provide appropriate reasoning or evidence to justify appeals.
  • Preparing and sending out denial letters.
  • You will be contacting and collaborating closely with third party payers, providers & CM & UR depts. to obtain additional info. necessary to request reconsideration of denied claims. Contact may be by phone, fax, e-mail or by mailing out appeal letters.
  • Coordinating the appeal process, preparing necessary documents and evidence to justify appeals.

Job Requirements

  • Active IL Registered Nurse License is required.
  • An Associate’s Degree in Nursing is required a Bachelor’s Degree is preferred.
  • A Covid-19 Vaccination is required as this is an onsite hospital-based position.
  • At least 2 years of recent medical claims denials and or appeals experience is required.
  • MS Office computer proficiency is required & w orking knowledge of Cerner is a plus.
  • Must be familiar with insurance and healthcare terminology & NCQA guidelines
  • Excellent written and verbal communication skills.

If you or anyone you know is interested, qualified and currently seeking employment please send an updated resume to us f or immediate review and consideration.

Job Requirements

See above job description 

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