RN DENIALS MANAGEMENT LEAD

Discover. Achieve. Succeed. #BeHere

Location: US:WI

This job is REMOTE.

FTE: 1.000000

Standard Hours: 40.00

Shift: Shift 1

Job Summary:

Responsible for developing and maintaining workflows for Enterprise Denials Management department, DRG denials, and other denial types as needed. Responsible for collecting, analyzing, and distributing denial and write-off data for federal, state and commercial payers. Identifies trends and issues related to denials and write offs. Works with other departments including Admitting, Health Information Management (HIM), Case Management, Utilization Review, Physician Advisors, clinical staff, Resource Management and Patient Financial Services (PFS) to implement process improvements for denial and write off reduction strategies. Provides education to Enterprise Denials Management team.

EXPERIENCE DESCRIPTION:

Minimum of five years of acute nursing experience in CDI, denials, or utilization review is required. Experience in denial management is preferred.

EDUCATION DESCRIPTION:

Bachelor's Degree in nursing is required. Professional knowledge of nursing theory and practice at a level normally acquired through the completion of a minimum of four years education at an accredited School of Nursing in order to be eligible for licensure as a Registered Nurse is required.

TRAINING DESCRIPTION:

Previous experience with clinical validation denial review and appeal processes. Knowledge of ICD-10 coding guidelines.

SPECIAL SKILLS DESCRIPTION:

Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel. Analytical skills necessary to prepare statistical reports and develop solutions to problem. Technical writing ability for appeal letters and reports. Leadership skills for education and feedback.

LICENSURE DESCRIPTION:

Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact).

Compensation, Benefits & Perks at Froedtert Health

Pay is expected to be between: (expressed as hourly) $38.92 - $60.33. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.

Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:

Paid time off

Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities

Academic Partnership with the Medical College of Wisconsin

Referral bonuses

Retirement plan - 403b

Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics

Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at . We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at . We will attempt to fulfill all reasonable accommodation requests.