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Job Description
Overview
Pay range for this position is $32.83 – $48.76/hour. Actual pay is based on years of licensure.
POSITION SUMMARY:
The Revenue Cycle (RC) Clinical Denials Coordinator is responsible for timely management of complex clinical/Utilization Medical Review (UMR) denials. 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:
- BSN within 3 years of hire date
Experience:
- 2 years of Clinical Denials and Appeals work 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 License
Other 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.
- Working knowledge of a clinical electronic medical record (EMR) system.
- Expertise in screening criteria and medical record review.
- Advanced analytical skill necessary to develop, implement, and administer policies, procedures, analyze financial and clinical data and prepare clear, concise reports that identify opportunities and propose appropriate action plans.
- Demonstrated skills in decision making abilities, independent judgement, creativity, prioritization/delegation, and time management.
OSF HealthCare is an Equal Opportunity Employer.
EOE/Minorities/Females/Vet/Disabled
Job seekers will be afforded equal opportunity regardless of their race, ethnicity, veteran status or disability status.
