RN Denial Prevention Consultant

Job Summary

A company is looking for a Denial Prevention Nurse Consultant.

Key Responsibilities

• Review medical records to determine billable services and construct appeals for payment
• Analyze and validate services related to billing for accuracy and compliance with payer guidelines
• Identify trends in denials and provide recommendations for best practices to clients

Required Qualifications

• Must be a Registered Nurse (RN) 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
• Working knowledge of patient accounting documents and healthcare billing software