Denial Prevention Nurse Consultant - RN

Job Summary

A company is looking for a Denial Prevention Nurse Consultant.

Key Responsibilities:

• Analyze medical records to determine appropriate billable services and construct appeals for payment based on medical necessity or payer guidelines
• Research and interpret medical documentation, manage care contracts, and insurance denials
• Perform denial trending, identify revenue cycle fail points, and provide best practice recommendations to clients

Required Qualifications:

• Must be an RN with a college degree or diploma from a school of nursing
• Minimum 5 years of experience in utilization review or patient accounting
• High proficiency with Interqual and MCG guidelines
• Working knowledge of patient accounting documents and healthcare billing software
• Experience with healthcare billing software and databases