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Claims Denial NurseLouisville, Kentucky

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Job # 404355 Date posted 04/22/2021

Description

We are recruiting for a Clinical Appeals Nurse to join our Clinical Denials Management Department for theHospital Division.  This is a work from home position that can live anywhere.

We currently have two (2) positions available.

Responsible for denial assessment, analysis of clinical documentation, and formulation of appeal letter when medical necessity and non-clinical denials are received from third party payers (government and non-government).   Writes claimappeal letters according to evidence in the medical record and defined appeal process.  Ensure timely submission of appeal letters, per internal expectations and payer guidelines.

Essential Functions:

  • Excellent writing skills.
  • Excellentcomputer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
  • Knowledge of accreditation standards and compliance requirements.
  • Knowledge of government and non-government payer practices, regulations, standards and reimbursement processes.
  • Knowledge of established national medical necessity guidelines (InterQual® level of care LTAC criteria, Milliman Care Guidelines® for LTAC).
  • Compose appeal letters for the Hospital Division, including Inpatient Rehabilitation Facilities (IRFs).
  • Ability to review medical, financial and admission criteria documentation to prepare well-written appeal letters.
  • Ability to communicate whether denial is substantiated or viable after review of medical, financial, and admission documentation.
  • Regularly review periodicals, web sites and other media for changes in current guidelines.
  • Provide educational material relative to types of claims and errors identified during review of medical and financial documentation.
  • Recommend projects that promote documentation improvement (i.e. form, ProTouch, other documentation standardization/ compliance projects) reducing risk of denied claims.

Knowledge/Skills/Abilities:

  • Working knowledge of healthcare law.
  • Strong written and verbal communication skills.
  • Ability to work with individuals at all levels of the organization.
  • Knowledge of long-term acute care industry.
  • Knowledge of state and federal regulations.
  • Proficient computer skills.
  • Ability to analyze, research, and interpret.

Qualifications

  • Bachelor's degree in clinical field required
  • Registered Nurse preferred
  • 5+years of experience in clinical setting required
  • 1+ years experience in hospital case management preferred
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Current Kindred Healthcare employees apply here.

  • Benefits and Recognition

    Benefits & Recognition Our goal is to offer valuable compensation and incentive programs that enables us to attract, reward, retain, and motivate highly qualified individuals. Compensation can include bonus plans and recognition for going above & beyond.

  • Healthcare

    Healthcare We offer a variety of Health Savings Account (HSA) and PPO plan options.

  • 401(k) Plan

    401(k) Plan Employees can contribute pre-tax dollars through payroll deduction.

  • Paid Time Off

    Paid Time Off Your work/life balance is important to us. We offer our employees a flexible Paid Time Off program.

  • Wellness Program

    Wellness Program We offer tools, resources and support for weight loss, stress reduction, smoking cessation and making overall healthier choices.

  • Community

    Community Community involvement is consistent with our company's principles and with our mission of customer service and quality care.

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You have high standards. So do we. Find your future with Kindred, the nation’s largest specialty hospital company. A career here will allow you to learn, thrive and grow in a positive and supportive environment where your input matters. Join us and see all that you can accomplish when you combine your talent, skills and dedication with a highly successful and compassionate healthcare leader.

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Nursing excellence practiced here. Kindred is the nation’s largest specialty hospital company, and our nurses are a big reason why. Here, you’ll engage our patients and their families by providing the skill, comfort and compassionate care needed for the best possible outcomes and reducing lengths of stay and unnecessary re-hospitalizations. Join our dedicated staff and gain valuable experience as you learn, grow and thrive in a positive and empowering environment.

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Rehabilitation is the key to everything we do. And our caring, compassionate therapists are proud to lead the way. As one of the largest providers of rehabilitation therapy in the country, we’ve been managing rehab for more than 30 years. Whether you are a physical, occupational or speech-language therapist, we have opportunities that allow you to provide exceptional care in an environment committed to career growth and continual learning and support.

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