Hospital Claims Denials Management Registered Nurse
Managed Care Staffers
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.
- 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.
- 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.
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