Job Title:RN Specialist Denials
Denials Nurse Scope of Responsibility:Performs all appeals for clinically related claim denials that occur in Patient Financial Services.
The Denials/Audit RN Specialist performs all appeals for clinically related claim denials across the Mercy Health ministry. Job duties include, but are not limited to, contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining if appeal is necessary, preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner. In addition, the RN Specialist will work closely with the Case Management Department and HIM Department to ensure denial trends and outcomes are communicated in a timely manner. The RN Specialist will perform these duties while meeting the mission and goals of the Mercy Health ministry, as well as meeting the regulatory compliance requirements.