West Virginia RN Clinical Denials Coordinator

Job Summary

A company is looking for a Clinical Denials Coordinator.

Key Responsibilities

• Report, monitor, and analyze clinical denials and coordinate appeals
• Evaluate patient medical records for discrepancies and negotiate billing issues with external auditors
• Develop training sessions and provide process improvement initiatives related to denials

Required Qualifications

• Current unencumbered RN license in state of residency or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
• Three (3) years of healthcare clinical experience
• Bachelor's Degree in Nursing or Associate of Science in Nursing Degree (ASN) or Diploma; currently enrolled in a BSN program with completion within three (3) years of hire
• Experience in Medical Management for Medicare and/or Medicaid populations is preferred
• Utilization Management experience is preferred