APPEALS DENIAL RECOVERY SPLST

H. Lee Moffitt Cancer Center

Tampa, FL

Job posting number: #7085424 (Ref:hlj_32837)

Posted: September 16, 2021

Application Deadline: Open Until Filled

Job Description

Position Highlights:

·     Responsible for the administration and coordination of the denials review and appeals management processes that includes denials management, claims recovery, and recovery audit contractor reviews.

 

The Ideal Candidate Will Have,
  

  • Preferred – Experience in oncology nursing, utilization review, quality management, and/or recent case management Soarian experience.

 

Responsibilities:

 

  • Submit appeals electronically and/or mail. Follow up electronically and/or telephonically with payers for claim and appeal status.  
  • Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted.  
  • Research and prepare responses for payer requests for additional information and documentation.
  • Review of clinical denials including identification of root cause.
  • Resolve clinical denials which include researching and reviewing payer guidelines, writing and submitting appeals with supporting documentation if required.
  • Identifies coding, billing, or reimbursement errors/discrepancies with the denial or aging claim in order to escalate to the denial recovery supervisor.
  • Denied dollars for both contracting and non-contracting insurance companies; and resolution of reimbursement discrepancies.
  • Resolution of denials for medical necessity, utilization review, pre-certification, authorization, and concurrent review to include writing appeals and responsible for conducting and preparing responses.
  • Prepares responses to Medicare recovery audits (RAC) reviews received by Moffitt Cancer Center from any government entity.
  • Claims Recovery
  • Provides Appeals/Denials Consulting and Support.
  • Other duties including special projects as assigned.

 

 

Credentials and Qualifications:

·     Bachelor's Degree required.

·    Registered Nursing (RN) license required.

·     A minimum of five (5) years healthcare experience required.

 

** “in lieu of" a RN license, a Licensed Practical Nursing (LPN) license with an additional two (2) years in a nursing role experience with a total of seven (7) years may be considered.

** “in lieu of" a Bachelor’s degree you must have an Associate’s degree plus an additional two (2) years for a total of seven (7) years of healthcare experience - preferably in Nursing.



Mission To create a Moffitt culture of diversity and inclusion as we strive to contribute to the prevention and cure of cancer. Vision Moffitt Cancer Center is recognized as the model wherein the diversity of our employees and communities is valued and supported as essential components to contributing to the prevention and cure of cancer. The cancer center is an equal opportunity employer. It is the policy of the cancer center to prohibit unlawful discrimination and harassment of any type and to afford equal employment opportunities to workforce members and applicants, regardless of race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, marital status, disability, genetic information, veteran’s status or any other characteristic protected by federal, state or local law.


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More Info

Job posting number:#7085424 (Ref:hlj_32837)
Application Deadline:Open Until Filled
Employer Location:H. Lee Moffitt Cancer Center
Tampa,Florida
United States
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