Compassion. Accountability. Collaboration. Foresight. Joy.
These are the Aspirus Core Values; and we are looking for the BEST around to join us as we demonstrate those values Every. Single. Day.
Aspirus Wausau Hospital in Wausau, WI is seeking a Registered Nurse – Denial Coordinator to join our team!
The RN Denial Coordinator combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for inpatient services. Collaborates with physicians, Care Coordinators, revenue cycle personnel and payers to appeal Medicare Advantage, Commercial, Medicaid and third-party payer denials.
The RN Denial Coordinator also monitors, evaluates and assists in the maintenance and improvement of efficient utilization of hospital resources through performance of pre-admission/admission and continued stay medical record reviews. The RN Denial Coordinator ensures that the program reduces and eliminates service delays and non-acute hospital days, monitors the quality of documentation and services provided, and makes recommendations for improvement.
HOURS: Full-Time or 1.0 FTE, 80 hours every pay day, Monday – Friday Day shift, may include weekend/holiday rotation
Experience/Qualifications
Knowledge of UM standards and patient care practices is normally acquired through graduation of an accredited school of professional nursing.Bachelor’s degree in nursing preferred.Successful completion of quality or Utilization Review certification examination, and active membership in professional organization (i.e., NAHQ, WAHO) beneficial.Case Management Certification preferred.Minimum of 3-5 years’ broad clinical experience, predominantly in acute inpatient nursing.Case Management, discharge planning, and UM experience preferred.Possesses an active Michigan or Wisconsin RN nursing license.Knowledge, understanding and application of various Hospitalization Healthcare Criteria (e.g., InterQual, Milliman, MIDAS, Medicare/Medicaid regulations).Knowledge of legal and regulatory issues including HIPAA, EMTALA, CMS Conditions of Participation, and reimbursement process as well as current reimbursement.Possesses strong clinical skills, assessment and good professional judgment, as well as broad-based knowledge of medical management, nursing management and medical terminology.Knowledge of anatomy and physiology; medical procedures; normal and abnormal clinical findings and their implications for care needs.Possesses general understanding and knowledge of: Medicare system, UM principles and objectives, Managed care indicators, Quality Improvement principles and Risk Management objectivesPossesses and exercises good public relations skills.Demonstrates Windows based computer skills.Possesses strong analytic, data management and computer skills. Can aggregate and report findings to assist in obtaining solutions. Demonstrates ability to engage in complex clinical decision-making.Possesses technical writing ability.Possesses excellent verbal and written communications skills. Demonstrates skill in interacting with physicians on a collegial basis.Demonstrates the ability to read and comprehend government regulations and contracts.Demonstrates familiarity and knowledge of medical records organization and procedures. Employee Benefits
Full benefits packages available for part- and full-time status.PTO accrual from day one!Generous retirement plan with match available.Wellness program for employees and their families.
Aspirus Wausau Hospital, the flagship of the Aspirus system, serves northeastern Minnesota, northern and central Wisconsin, and Michigan’s Upper Peninsula. Aspirus Wausau Hospital provides primary, secondary and tertiary care services as a regional referral center. Specialty referral service emphasis exists in cardiology and cardiothoracic surgery, orthopedics and cancer. The hospital has an average daily inpatient census of 160 with approximately 15,000 admissions per year. Outpatient visits exceed 50,000 and there are also more than 24,000 annual emergency department visits. Best known for its world-class cardiovascular program, Aspirus Wausau Hospital also provides leading edge cancer, trauma, women’s health, and spine and neurological care. To learn more about Wausau click the following link: Wausau, Wisconsin
Our Mission: We heal people, promote health and strengthen communities.
Our Vision: Aspirus is a catalyst for creating healthy, thriving communities, trusted and engaged above all others.
As an Aspirus team, we demonstrate caring, we plan to impact the future, work with happiness and enthusiasm, recognize our power to make a difference and improve the health of our communities.
Aspirus Health is a nonprofit, community-directed health system based in Wausau, Wisconsin, serving northeastern Minnesota, northern and central Wisconsin and the Upper Peninsula of Michigan. The health system operates 18 hospitals and 130 outpatient locations with nearly 14,000 team members, including 1,300 employed physicians and advanced practice clinicians. For more information visit aspirus.org.
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Credentials:
Essential:
* REGISTERED NURSE LICENSE