Clinical Denials Specialist

Company: United Health Services
Location: Binghamton
Posted on: January 10, 2020

Job Description:

Position Overview Serves as the primary representative from Care Management to employ best practices of Denial Management. The prevention of denials in a proactive fashion. The analysis of a denial or a potential denial and make determinations as to the options to avoid or mitigate a denial. The ability to garner resources across the system including physician, other providers, clinical staff and administrative / financial staff to problem solve and create solutions that best suits the needs of the patient and the organization. Denial management activities include investigating and actively appealing claims, tracking and reporting denial trends and educating Care Managers and medical staff to prevent future denials Position#Requirements Education/Experience Minimum Required: Associate#s in Applied Science in Nursing with a minimum of five years of experience in acute/tertiary facility Preferred: Bachelor#s of Science in Nursing with three years of experience in acute / tertiary facility, denial management and/or revenue cycle experience License/Certification Minimum Required: Minimum Required: NYS Licensed Registered Nurse Preferred: JobSummaryDisplay: * Position Overview * Serves as the primary representative from Care Management to employ best practices of Denial Management. The prevention of denials in a proactive fashion. The analysis of a denial or a potential denial and make determinations as to the options to avoid or mitigate a denial. The ability to garner resources across the system including physician, other providers, clinical staff and administrative / financial staff to problem solve and create solutions that best suits the needs of the patient and the organization. Denial management activities include investigating and actively appealing claims, tracking and reporting denial trends and educating Care Managers and medical staff to prevent future denials * Position Requirements * Education/Experience * Minimum Required: * Associate's in Applied Science in Nursing with a minimum of five years of experience in acute/tertiary facility * Preferred: * Bachelor's of Science in Nursing with three years of experience in acute / tertiary facility, denial management and/or revenue cycle experience * License/Certification * Minimum Required: * Minimum Required: NYS Licensed Registered Nurse * Preferred:

Keywords: United Health Services, Binghamton , Clinical Denials Specialist, Healthcare , Binghamton, New York