Sep 23, 2021

Clinical Denial Appeals Registered Nurse / Patient Financial Services / Full-Time / Days

  • Ardent Health Services
  • Albuquerque, NM, USA
General Nursing

Job Description

Job Description

Clinical Denial Appeals Registered Nurse, Patient Financial Services, Full-time, Days, Albuquerque, NM.

We are looking for a Clinical Denial Appeals RN to join our Patient Financial Services team, in Albuquerque NM. This position is remote or office based.

This full-time job is located at Lovelace Central Business Offices in Albuquerque: Organizational Position supports facilities for all Lovelace, Hillcrest & University of Kansas hospitals. We are dedicated to exceeding our customers’ expectations in every way.

Registered Nurse Clinical Denial Appeals Job Responsibilities:

  • This position is to assess and utilize clinical and financial information to effectively appeal claim denials after service is provided related to Level of Care, Medical Necessity & continued authorization related to IP and OBS claims.
  • Ability to effectively write appeals with all required information needed to overturn denials.

  • Must be able to work flexible hours, at the ABQ office or remotely.

  • In partnership with patients, physicians, and other health care providers, this position will support utilization of resources and obtain appropriate & optimal reimbursement to assure maximum appropriate reimbursement for the organization.

  • Position identifies trends and disseminates as necessary for appropriate action

  • All work processed by the incumbent is confidential.

  • Completes established competencies for the position within designated introductory period.

  • Other related duties as assigned.


Registered Nurse Clinical Denial Appeals Education and Experience Job Requirements:

  • Minimum: Associate’s Degree or Diploma of Nursing

  • Desired: Bachelor’s Degree in Nursing

  • 5 years clinical nursing experience and two years managed care experience.

  • Knowledge of the operations of patient billing; the UB -04, the Itemized Statement, coding information reported on claim and grievance procedures.

  • Demonstrated knowledge of the State Medicaid structure and other insurance
    plans (i.e., commercial, Medicare, HMO/PPOs, etc.)

  • Valid NM Nursing license or NM compact license (within 90 days of hire)

  • BLS; HIRING DEPARTMENT MAY ALSO REQUIRE ACLS and or PALS.

Why Lovelace?

  • Named one of the 150 Great Places to Workin Healthcare by Becker's Hospital Review

  • Named one of the Best Places to Work by Albuquerque Business First

  • Named Top Workplace by Albuquerque Journal ,2013, 2014, and 2015

  • Named to Modern Healthcare's 100 Best Places to Workfive times since2008

Lovelace is a drug-free employer with smoke free campuses.