Greensburg, Pennsylvania
Denial Managment Specialist - Job Opening in Greensburg, Pennsylvania - If interested in the position please complete an application on .
Requisition number is 17-0053
The Denial Management Specialist demonstrates the ability to communicate effectively with all members of the healthcare team, both internal and external. The Denial Management Specialist will assist the Lead Denial Management Specialist with communication of clinically-based appeals between Excela Health and outside payors. This individual will review each case identified for appeal and apply InterQual and other relevant screening criteria, including the Medicare Benefit Policy Manual, to determine the viability of the appeal and manage the appeal process through the various stages as appropriate.
Actively promotes a Lean work culture by performing team member duties to encourage consistent use of LEAN principles and processes, including continually seeking work process improvements. Recognizes the necessity of taking ownership of one?s own motivation, morale, performance and professional development. Strives for behavior consistent with being committed to Excela?s missions, vision and values.
Graduate of an accredited Nursing Program * BSN or acquired within five (5) years from date of hire. Certification / Licensure / Regulation: * Current licensure to practice as a Registered Nurse in the State of Pennsylvania
Prior Experience: * Three years clinical experience in healthcare / recent case management experience. Must have proficient documentation skills. Be able to work well with diverse and challenging populations, maintain appropriate professional boundaries and have the ability to remain calm during crisis situations. Other Skills and Abilities: * Knowledge of Payor/Insurance Benefits * Functional Skills on PC and Related Software (Microsoft Office) * Knowledge of basic Office Equipment such as copier, fax machine, etc. * Proficiency in the use of Excel Spreadsheets, PowerPoint, and various software programs * Excellent communication, interpersonal and organizational skills * Strong leadership ability, independent thinking and decision-making ability; analytical problem solving skills, sound judgment; excellent oral and written communication skills, must be able to function in a team environment. * Ability to communicate with all members of the health care team * Ability to multi-task and prioritize assignments * Working knowledge of InterQual level of care criteria and other relevant medical necessity screening tools, including the Medicare Benefit Policy Manual; third party payor denial and appeal processes.
Preferred Factor: These are job related enhancements that are preferred or would benefit the performance outcome of the job but are not essential or required for the job to exist. * Case Management Certification, recent denial and appeal experience
Job Type: Part-time
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