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Pay range for this position is $37.05 - $54.54/hour. Actual pay is based on years of licensure. This is a Salaried position.
Overview
POSITION SUMMARY: The Revenue Cycle (RC) Clinical Denials Coordinator is responsible for timely management of complex clinical/Utilization Medical Review (UMR) denials. The Clinical Denials Coordinator is responsible for the secondary review of patients not meeting inpatient criteria to determine correct patient class of outpatient, outpatient with observation services and inpatient. Understands payer requirements and payer appeal process in order to effectively reach resolution and overturn the denial for payment. Responsible for identifying root cause and solutions for denial prevention that will be shared with leadership for appropriate execution, education, and training as necessary.
Qualifications
REQUIRED QUALIFICATIONS:
Education: Bachelors in NursingExperience: 2 years of UMR work experience experience.3 years of clinical experience in order to gain comprehensive knowledge and expertise needed to develop a strategic perspective and independently solve complex process problems in a collaborative manner in a rapidly changing healthcare environment.Licensure/ Certification: IL Reg Nurse LicenseOther Skills/ Knowledge: Excellent interpersonal and communication skills. Solid computer skills, including proficiency with Microsoft software. Strong analytical and problem solving skills, with the ability to be detail oriented.
PREFERRED QUALIFICATIONS:
Experience:
OSF HealthCare is an Equal Opportunity Employer.