Job Information
Rush Copley Medical Center Appeals Specialist RN in Aurora, Illinois
Position Summary : The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after physician-to-physician (P2P) discussions then conducts appeals, as appropriate. Monitors and tracks denial outcomes with assistance from appeals team, identifies trends and works collaboratively with physician advisor team (PAT), providers, utilization management, coders, insurance companies and revenue cycle leadership to prevent future clinical denials by communicating denial root causes and help develop education and process changes. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.
Special Skills
Clear and concise verbal and written communication skills.
Math skills.
Experience multi-tasking.
Organized, attentive to details, and self-motivated.
Experience
Knowledge/experience in utilization management, denials and/or appeals management in hospital or physician denials desired.
Knowledge of clinical criteria for medical necessity; hospital & physician revenue cycle; and compliant coding/billing practices.
Extensive knowledge of federal, state and payer specific regulations and policies pertaining to documentation, coding and billing, with demonstrated ability to interpret such guidelines.
Demonstrates an advanced knowledge and skill in analyzing patient records to identify non-conformances in CPT, ICD-10 CM and HCPCS code.
Knowledge of Epic applications with focus on Resolute Hospital Billing.
POSITION REQUIREMENTS
License: Registered Nurse (RN) in the State of IL with at least 3 years of experience in clinical setting.
Education: Associate’s Degree in Nursing (ADN) required, Bachelor’s of Science in Nursing (BSN) preferred. BSN required within 5 years of hire.
Certifications: Specialty Certification preferred.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status and other legally protected characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting rush_recruitment@rush.edu.
