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Clinical Appeals Nurse - (242843)

Universal Health Services

Job Code:
Universal Health Services
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Job Details

Deltek Talent Management - Clinical Appeals Nurse - (242843)

Job Details

Clinical Appeals Nurse - (242843)

Facility Name
Atlantic Region CBO
RICHMOND, VA 23227 US (Primary)
Career Area
Registered Nurse (RN)
Job Description

Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected healthcare management companies, operating through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory centers nationwide. Founded in 1978, UHS subsidiaries now have more than 65,000 employees. The UHS business strategy is to build or purchase healthcare properties in rapidly growing markets and create a strong franchise based on exceptional service and effective cost control. Our success comes from a responsive management style and a service philosophy based on integrity, competence and compassion. The primary responsibility of the Clinical Appeals Nurse is to manage all activities related to monitoring, interpreting and appealing denials received from third party payers and ensuring accuracy in patient billing. ESSENTIAL JOB DUTIES: 1. Analyze trends in insurance denials and work with insurance companies to implement ways to resolve underlying reasons for denials. 2. Manage recurring coding or clinical documentation issues and correct the underlying causes for error. 3. Use discretion, knowledge and independent judgment to resolve escalated Clinical Appeals issues. 4. Work as a liaison between Clinical Appeals and other departments to conduct billing and charging compliance in accordance with applicable Federal and State laws. 5. Perform QA for Clinical Appeals function. 6. Perform insurance defense audits as requested. 7. Consistently demonstrates HIPAA compliance with regard to patients’ protected health information. 8. Provides clinical knowledge for CBO staff and consultation to management as needed. 9. Manage daily activities related to the CBO’s Clinical Appeals function; ensuring processes are performed efficiently and effectively. 10. Other duties as assigned.

Job Requirements

The following are the job requirements for the Clinical Appeals Nurse: 1. RN licensure in good standing is required. 2. Three to five years experience

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