We are seeking a Managed Care Denial Specialist for our center to ensure that we continue to provide all patients with high quality, efficient care. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply now!
We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.
Healthcare Corporation of America (HCA) is a community of 94,000 Registered Nurses and 38,000 active physicians. We have over 1,900 facilities ranging from hospitals, freestanding ER’s, ambulatory surgery centers, and urgent care clinics. Our facility based staff continues to raise the bar in patient care. Ten HCA hospitals have been named in IBM Watson Health’s top 100 best-performing hospitals based on patient satisfaction and operational data.
HealthONE® is the largest healthcare system in the metro Denver area with more than 10,000 employees. As part of the HealthONE family, The Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rocky Mountain Hospital for Children, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center, and Spalding Rehabilitation Hospital work together to provide a higher level of care. In addition, our family of services includes seven free-standing emergency departments, numerous ambulatory surgery centers, CareNow Urgent Care Clinics & Occupational Medicine, physician practices, and AIRLIFE-DENVER, which provides critical care air and ground transportation across a 10-state region.
We are committed to each other because when we join together, our patients are cared for in the safest and most compassionate way. Are you looking for an employer with many different career options and a people-focused culture? You've come to the right place.
•The Medical Center of Aurora: Magnet® designated hospital, Level II Trauma Center, 346 licensed beds •North Suburban Medical Center: Level III Trauma Center, 157 licensed beds •Presbyterian/St. Luke’s Medical Center & Rocky Mountain Hospital for Children: Level II Trauma Center, 680 licensed beds •Rose Medical Center: Magnet® designated hospital, Level II Trauma, 422 licensed beds •Sky Ridge Medical Center: Level II Trauma, 274 licensed beds •Swedish Medical Center: Level I Trauma, 408 licensed beds •Spalding Rehabilitation Hospital: 78 licensed beds •Behavioral Health and Wellness Center at the Medical Center of Aurora: 120 licensed beds
The Managed Care Denial Specialist will be accountable and responsible for working with the Corporate URS team and Physician Advisor on denials. This individual will interact with Continental Division and HealthONE facility leadership, Corporate URS team, AVP of Case Management, Physician Advisor, payers, auditors and the Shared Service Center (SSC) to facilitate communication and actions related to the denial management processes.
•Identification of strategies for prevention of status denials.
•As status denial trends are recognized, work in partnership with the corporate utilization team and Physician Advisor to implement strategies.
•Conduct daily collaborative calls with Corporate URS team Hospital personnel related to status disagreements (I/P vs OBS) and delay in discharge cases that result in denials.
•Maintains current knowledge of commercial payer denial and authorization strategies/ practices along with contractual agreements.
•Possess current knowledge of CMS, Corporate and Division UR requirements and billing procedures.
•Manage the P2P process and work with Physician Advisor on education to Hospital Physicians conducting P2P’s.
•Work with AVP of Case Management on obs vs I/P strategies
•Monitor P2P’s and obs vs I/P cases using an excel spreadsheet
•Monitor NSY reports to identify moms not meeting the 48/96 hour rule.
•Practice and adheres to the HealthONE/HCA corporate culture, “Code of Conduct” and “Mission and Value Statements.”
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply. We promptly review all applications. If you are highly qualified you will hear from one of our managers. Come unlock the possibilities and apply today
•Exceptional written and verbal communications skills. •Must be proficient in excel, have fast typing and 10 key skills •Conducts all activities with personal integrity, dignity, respect and civility. •Proficient in Microsoft Office applications, Internet searches, and relevant data bases (OnBase, ARTIVA, Meditech, MIDAS, HPF). •Proficient working independently on time sensitive projects. •Maintains long-term customer relationships, building trust and respect by consistently meeting or exceeding expectations. •Works effectively with physicians, employees, associates and external parties. •Demonstrates a mastery of observation management approaches.
EDUCATION •Bachelors Degree in Nursing
EXPERIENCE •Minimum of 3-5 years of Acute Hospital UR experience preferred
CERTIFICATE/LICENSE – Possesses active State of Colorado nursing RN) license.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.
For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.
Join our HealthONE family -- the largest healthcare system in the Denver metro area. Eight world-class hospitals. 40+ outpatient facilities. Countless opportunities.HealthONE is an equal opportunity employer.