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RN - Denials Prevention - Hospital Claims 8/26/2016

USA Recruiting Associates Miami, FL

Company
USA Recruiting Associates
Job Classification
Full Time
Company Ref #
29280009
AJE Ref #
575989497
Location
Miami, FL
Job Type
Regular

JOB DESCRIPTION

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_** This is a new search. We need an RN with hospital experience interested in a claims related position._

_ _

_Search For: RN, ER, ICU, Med-Surg, Transplant Unit._

DO NOT POST INFO ABOVE

Position Title RN - Denials Prevention - Hospital Claims - FL #3341

Relocation No

Location Miami Florida

Position Summary: Responsible for working with all hospitals and applicable staff at assigned client reduce and prevent payor denials of claims.

Essential Duties and Responsibilities:

Analyze monthly reports by trends, hospital, payor, and reason in order to identify operational issues causing denials

Work with all applicable departments and staff to develop processes to reduce and prevent future denials

Review managed care contracts, hospital billing statements/bills, and insurance denials

Communicate with hospital and payor personnel concerning all issues relating to denials

Present initiatives and results at meetings

Maintain confidentiality of information in compliance with company policy and HIPAA

Maintain regular contact with necessary parties including payors, clients, managers, and other company personnel

Build strong, lasting relationships with clients, payors and company personnel

Attend client, department and company meetings

Comply with federal and state laws, company and department policies and procedures

All other duties as assigned

Essential Skills and Experience:

College degree or diploma from school of nursing - must be RN

Clinical nursing experience working in hospital environment, preferably in ER, ICU, Med-Surg or Transplant Unit

Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook

Excellent interpersonal and communication skills

Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division

Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form

Ability to present written routine correspondence (in English)

Ability to define problems, collect data, establish facts and draw valid conclusions

Strong customer service orientation

Excellent interpersonal and communication skills

Strong team player

Commitment to company values

Ability to travel.

BOTTOM LINE REQUIREMENTS WE NEED NOTES ON WITH CANDIDATE SUBMITTAL:

1. COLLEGE DEGREE OR DIPLOMA FROM SCHOOL OF NURSING.

2. RN.

3. CLINICAL NURSING EXPERIENCE WORKING IN HOSPITAL ENVIRONMENT, PREFERABLY IN ER, ICU, MED-SURG OR TRANSPLANT UNIT.

4. MATHEMATICAL SKILLS: ABILITY TO CALCULATE RATES USING ADDITION, SUBTRACTION, MULTIPLICATION AND DIVISION.

5. ABILITY TO READ AND INTERPRET AN EXTENSIVE VARIETY OF DOCUMENTS SUCH AS CONTRACTS, CLAIMS, INSTRUCTIONS, POLICIES AND PROCEDURES IN WRITTEN (IN ENGLISH) AND DIAGRAM FORM.

6. SALARY REQUIREMENT