Denials Specialist RN - Utilization Review

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

The Denials Specialist-Utilization Review responsibilities include:

• Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity.
• Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members.
• Maintains and coordinates a timely appeal process or effectuates a correction of billing status.
• Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.

Position details:

• Location: Hybrid - Tampa/St Petersburg
• Status: Full time, 40 hours per week. Exempt
• Schedule: Monday - Friday 7:00 AM - 3:30 PM(can be flexible)
• Weekend Requirement: Occasional
• On Call: No

Certifications and Licensure:

• Required RN License
• Preferred Accredited Case Manager Certification
• Preferred Certified Case Manager

Education and Experience:

• Required 4 years RN experience with ASN and 2 years RN experience with BSN
• Required 2 years Utilization Review OR Care Coordination/Case Management OR Managed Care OR Finance experience
• Preferred Masters Degree in Nursing
• Preferred 6 months Denials Management
• Preferred 1 year Medicaid/Medicare experience

Benefits:

• Benefits (Health, Dental, Vision)
• Paid time off
• Tuition reimbursement
• 401k match and additional yearly contribution
• Yearly performance appraisals and team award bonus
• Community discounts and more

Equal Opportunity Employer Veterans/Disabled