Utilization Management Appeals and Denials Nurse - Case Management at Legacy Health – Portland, Oregon

Legacy Health

Utilization Management Appeals and Denials Nurse - Case Management

Equal Opportunity Employer/Vet/Disabled
US-OR-

Job ID: 26-46401
Type: Supplemental
Homebased EE Oregon

Overview

You are the voice, the coordinator and the empathetic advocate of patients facing difficult situations. Your compassion for patients and families with acute and chronic health conditions knows no limits. You are committed to working with healthcare teams to ensure every patient receives the care, comfort and dignity they deserve. If this is how you define your role as a Case Manager, we invite you to consider this opportunity.

Responsibilities

The UM Appeals and Denial Nurse, supports, and assists with LHS financial viability through focusing on appeals and denials, billing compliance and cooperative efforts to achieve overall Utilization Management team goals. This position supports the Utilization Management department in maximizing revenue and by providing input regarding appeals and denials. The UM Appeals and Denials Nurse works closely with the Physician Advisor and the appeals management team in writing appeal letters, development and education regarding the revenue cycle process. UM Appeals and Denials Nurse will track financial metrics (example % of appeals won).

Qualifications

Education:

• Academic degree in nursing (BSN or MSN/MN) required; MSN/MN preferred.

Experience:

• Five years acute care nursing experience required.
• Five years of healthcare utilization management experience preferred.
• Familiarity with office automation technology preferred.
• Quality assurance, project management, leadership and training skills also preferred.

Skills:

• Excellent analytical skills to perform analysis and provide recommendations on charge capture and documentation.
• Excellent documentation skills.
• Strong written and verbal communication skills to work directly with all levels of LHS staff, management and physicians, as well as liaison with consultants and vendors.
• Strong organizational and prioritization skills.
• Demonstrated knowledge of billing process including registration, authorization, and insurance denials.
• Demonstrated knowledge of billing/collection rules and regulations.
• Ability to work with credibility and effectiveness with medical and administrative staff.
• Ability to withstand varying job pressures and organize and prioritize related tasks.
• Ability to work efficiently with minimal supervision, exercising independent judgment within stated guidelines.
• Ability to perform the competencies and essential functions of the job as outlined.