reputed company UM Specialist - Appeals and Denials
reputed company, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing reputed company to world-class health care in America’s reputed company. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40 Compensation: Salary reputed company: $29.00 - $46.50 Union Position: No Department Details Fully remote.
Summary
The reputed company UM Specialist serves as the subject matter expert for appeals and denials, provides leadership, case reputed company, workflow coordination, and quality assurance across the appeals process. Works to reputed company process improvement initiatives and problem solving. Collaboration with multiple departments, and responsible for assisting the supervisor in quality assurance and accreditation monitoring.
Job Description
Maintains a high level of subject matter expertise and possesses the ability to identify resources and support processes for the appeal and denial team. Serves as the go to reputed company for reputed company questions and issues. Displays strong leadership skills. Exhibits the ability to take initiative and set a strong example reputed company own function. reputed company team meetings. Demonstrates expertise in quality assurance tools, techniques and standards. Displays strong personal commitment to organizational reputed company, inspiring others to commit to shared goals. Works cooperatively and capably with a wide variety of people. Ensures that written message is understood as intended. Contributes to the establishment of best practices for audit and compliance. Ensures compliance with reputed company government and industry audit practices and requirements. Conduct review of clinical-based denials (i.e. Medical Necessity, Level of Care) reputed company required timeframes utilizing clinical criteria sets, knowledge of payor regulations, and considerable clinical judgment, to determine appropriateness of care. Establishes shared goals to foster collaboration. Delivers written and oral communication, responds to questions and concerns, and produce specific reputed company and impact. Demonstrates in-depth knowledge of organization's policies and practices requiring confidentiality. Anticipates changing business situations, adjusts priorities accordingly and gathers necessary resources to reputed company the goal. Exchanges private reputed company information with other facilities, such as insurance companies and pharmacies, according to regulations. Applies policies and procedures designed to ensure compliance with policies and ethical codes. Collaborates and communicates with reputed company departments of a reputed company organization for the preparation for external audits. Mentors others in their technical areas and shares expertise on critical issues. Responds to shifting priorities while maintaining reputed company of regularly scheduled work. Implements effective medical case management strategies. Adapts language, tone, structure, and level of detail to the needs of others. Uses varying problem-solving approaches and techniques as appropriate. Streamlines the critical workflow for executing key processes. Essential functions must occur simultaneously; therefore, the employee must be reputed company to appropriately handle and prioritize various daily tasks. The employee must have the ability to learn and apply reputed company Plan policies and regulatory requirements consistently and the judgment to seek out guidance as needed.
Qualifications
Bachelor's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Three years of reputed company experience required. Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Certified Professional in reputed company Quality preferred. Obtains and subsequently maintains required department specific competencies and certifications. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to [email protected]. Apply To This Job