Description

American Traveler is seeking an experienced RN Case Manager with strong clinical denial management and appeal writing skills for a daytime role.

Details

• Position is in a hospital case management department focused on clinical denials
• Day shift schedule from 8:00 am to 5:00 pm, five days per week
• Role involves managing a work queue of accounts receivable and conducting comprehensive reviews of denied accounts
• Use of Epic EMR and other systems within the revenue cycle
• Eligible candidates within a 60-mile radius are considered local

Requirements

• Active FL or compact RN license required at the time of consideration
• Current BLS and ACLS certifications from AHA or ARC, and NIH Stroke Scale (NIHSS)
• At least two years of recent consecutive acute care or case management experience in a US hospital within the past 24 months
• Experience with clinical appeal letter writing and demonstrated proficiency in revenue cycle EMR workflows
• Epic EMR experience required
• Degree from an accredited nursing school or approved by FBON
• Proof of vaccination status required; declinations not accepted
• Pass/fail EKG testing required for certain clinical areas

Additional Information

• Responsible for reviewing denial reasons, researching payer policies, and submitting timely and effective appeals
• Will communicate payer trends and issues related to denials
• Expected to set and execute follow-up activities based on claim status
• Remain current with CMS guidelines and payer-specific contracts
• Smoke-free work environment
• Study guide and orientation materials are provided online to support success in required assessments
• Locals are accepted but receive a lower local rate
• Must meet specific scores in dysrhythmia assessment before starting