Unity Health · 3 days ago
Clinical Denials Audit Analyst RN, Full Time
Searcy, AR
Full-time
Onsite
Entry, Mid Level
2+ years expUnity Health is a healthcare provider focused on delivering quality patient care. They are seeking a Clinical Denials Audit Analyst RN to manage claim denials, write and submit professional appeals, and handle audit-related compliance responsibilities to support hospital and physician reimbursement.
Health CareHospitalMedicalNon Profit
Responsibilities
Perform advanced level work related to clinical denial management
Manage claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, etc
Assist with the tracking notification and following of denials in Compliance 360
Write and submit professional appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language and coding guidelines
Submit appeals timely and track through until final outcome
Handle audit-related / compliance responsibilities and other administrative duties as required
Work independently to plan, schedule, and organize activities that directly impact hospital and physician reimbursement and assist in creating and maintaining documentation of key processes
Qualification
Required
Minimum of an associate's degree in nursing is required
Requires a current RN license for the state of Arkansas
Must have two (2) years of relevant experience
Minimum of two (2) years' recent experience in hospital case management and/or hospital revenue cycle required
Should have experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms
Should have knowledge of Medicare, Medicaid and third-party reimbursement methodologies and of local, state and federal healthcare regulations
Must have the ability to make good decisions in demanding situations
Must have effective communication skills
Must have the ability to listen empathically
Must have the ability to manage multiple tasks easily and efficiently
Must have the ability to work independently and be results oriented
Must have the ability to multitask and use various computer applications
Basic math skills and knowledge of general accounting principles are necessary
Preferred
BSN is preferred
Three (3) years of experience in a healthcare revenue cycle or clinic operations role with one (1) of those years being in a role which included claim-related appeal writing is preferred
Should possess extensive writing capabilities and the ability to organize details logically and accurately
Company
Unity Health
Unity Health is a healthcare center that offers patient and family advisory council services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Phil Miller
Asst. Vice President/CIO
Roddy Lochala
Chief Medical Officer
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