RN Denial Prevention Consultant

Job Summary

A company is looking for a Denial Prevention Nurse Consultant.

Key Responsibilities

• Review medical records and documentation to determine billable services and construct appeals for payment
• Analyze trends and provide recommendations for revenue cycle fail points and best practices
• Communicate with clients and payors to resolve underpayments and denials

Required Qualifications

• Must be a Registered Nurse with a college degree or diploma from a nursing school
• Minimum of 5 years of experience in utilization review or patient accounting
• Clinical nursing experience in a hospital environment, preferably in ER or Critical Care
• Proficiency with Interqual and MCG guidelines
• Familiarity with patient accounting documents such as UB04 and EOB