RN Coordinator - Clinical Denials/Appeals / Detroit / Full Time Day Shift

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Nursing
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198955 Requisition #

A new opportunity is available for a RN Coordinator – Denials/Appeals at the Henry Ford Hospital in midtown Detroit.
BSN RN’s with 3 years of experience in utilization review, case management, or appeals/denials, are qualified to apply.
This position is an office environment desk job utilizing a desk top computer. Medium level computer skills are necessary for the position.

• Position: Full time 40 hours per week
• Shift: Days 7:30 am to 4:00 pm or 9 am to 5:30 pm
• Benefits: Full time benefit package
• Office attire
• This pay rate is different than the inpatient, hospital nursing rates.

GENERAL OVERVIEW:
Under minimal supervision, this position specializes in follow-up of denied and rejected claims from all commercial, contracted and non-contracted payers, including preparing appeal letters. Reviews all denials for medical necessity and appeal ability utilizing clinical judgment and applying InterQual criteria. Provides clinical utilization management expertise. Provides education, formal and informal, to facilitate denial management strategies. Serves as a liaison to key customers that include ancillary departments, physicians and payers.

MAJOR RESPONSIBILITIES:
• Familiarity with all aspects of utilization/denial management and expertise to analyze if all admitted patients are appropriate for services requested and rendered.
• Communicates to obtain required authorizations for treatment from the respective insurance payors.
• Refers denied cases to the assigned PAS (Physician Advisory Services) personnel to determine next steps after initial review.
• Demonstrates a strong clinical knowledge base to review developmentally appropriate assessment, plan of care and the interventions for patient outcome.
• Utilizes clinical judgment, including applying Interqual screening to evaluate denied claims for potential appeal.
• Reviews payer denial/rejection rationale and develop rebuttal appeal within the timely filing timeframes, per insurance payer.
• Provides timely response to payer requests, inquiries and/or complaints.
• Tracks and inputs pertinent information to the appropriate system(s) and the tracking log.
• Update ECIN and other programs to reflect current status of accounts, such as appeal, approval and denial decisions as received by insurance company response.
• Assumes responsibility for maintaining tracking of all denials and appeals, including copies of all letters for the appeal process, authorization numbers, avoidable days and dollars recovered.
• Liaison to medical records and patient financial services regarding medical documentation for level of care, coding and correct billing status, including release of bills when suppressed for pending appeal.

EDUCATION/EXPERIENCE:


• Registered Nurse with a valid, unrestricted, State of Michigan License required.
• Minimum 3-5 years of clinical experience required.
• Bachelor of Science Nursing required or three years Denial/Appeal/Utilization Management experience.
• Previous experience with InterQual system.

    Overview

       Under the leadership of President and CEO Wright L. Lassiter, III, Henry Ford Health System is a

       $6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

       including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

       other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

       now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

       of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the

       health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s  

       major academic medical centers, receiving between $90-$100 million in annual research funding and

       remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical

       education and training, the health system has trained nearly 40% of physicians currently practicing

       in the state and also provides education and training for other health professionals including nurses,

       pharmacists, radiology and respiratory technicians. visit HenryFord.com.

     Benefits

       Whether it's offering a new medical option, helping you make healthier lifestyle choices or

       making the employee enrollment selection experience easier, it's all about choice.  Henry

       Ford Health System has a new approach for its employee benefits program - My Choice

       Rewards.  My Choice Rewards is a program as diverse as the people it serves.  There are

       dozens of options for all of our employees including compensation, benefits, work/life balance

       and learning - options that enhance your career and add value to your personal life.  As an

       employee you are provided access to Retirement Programs, an Employee Assistance Program

       (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness,                 and a whole host of other benefits and services.  Employee's classified as contingent status are not         eligible for benefits.    

      Equal Employment Opportunity/Affirmative Action Employer

        Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is

        committed to the hiring, advancement and fair treatment of all individuals without regard to

        race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

        weight, marital status, family status, gender identity, sexual orientation, and genetic information,

        or any other protected status in accordance with applicable federal and state laws.

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