Jan 08, 2021

Utilization Denials Specialist

  • BayCare Health System
  • Tampa, FL, USA

Job Description

Utilization Denials Specialist(Job Number: 205990) Description   The Utilization Denials Specialist is responsible for timely review of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity. Working closely with the Physician Advisor, Registration, Patient Accounts, and Coding department team members, the Utilization Denials Specialist 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. Qualifications   Certifications and Licensures Required RN (Registered Nurse) Education Required Associate's Nursing Preferred Bachelor's Related Field Experience Required 1 year Utilization Review Required 4 years Nursing Preferred 2 years Utilization Review Preferred 1 year Managed Care Preferred 2 years Case Management Preferred 6 months Denials Management Preferred 1 year Medicaid Preferred 1 year Medicare Specific Skills Required Customer service skills Required Written and verbal communication skills Required Interpersonal skills Required Time management skills Required Analytical Skills Required Knowledge of regulatory standards appropriate to position Required Work independently Required Computer skills appropriate to position Required Organizational skills Required Quality Improvement     Organization: 5105-SOUTH FLORIDA BAPTIST HOSPITAL Primary Location: FL-Tampa-St. Joseph's Hospital Schedule: Monday, Tuesday, Wednesday, Thursday, Friday Shift: Days Shift Hours: 7:30 AM - 4:00 PM Weekend Work: None On Call: No Employment Status: ACTIVE FULL TIME Equal Opportunity Employer Veterans/Disabled