State Licensed Denial Prevention Nurse
Job Summary
To support hospitals in revenue recovery, the full-time State Licensed Denial Prevention Nurse will analyze medical records and documentation to validate billable services, construct appeals for payment, and provide clients with revenue cycle analysis and best practice recommendations while working remotely.
Key responsibilities
- Analyze medical records and documentation to validate services and prepare appeals for payment
- Identify fail points within the revenue cycle and provide remediation recommendations to clients
- Maintain communication with clients and payors regarding claims status and resolve underpayments or denials
Required qualifications
- 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
- Proficiency with Interqual and MCG guidelines for claim appeals
- Understanding of patient accounting documents such as UB04 and EOB
- Experience with healthcare billing software and databases like EPIC, Cerner, or Meditech
Complete Job Description
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