Northside Hospital

Clinical Audit/Denials Specialist, RN

Northside Hospital  •  Atlanta, GA (Onsite)  •  1 hour ago
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Job Description

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

Responsibilities

Processes, tracks and appeals clinical denials. Supports and facilitates the design, development and implementation of Utilization Management data collection methodologies and studies in the respective functional areas. Displays and analyzes data to identify trends. Works collaboratively to develop plan of action.

Qualifications

REQUIRED

Case Management

  • Graduate of an accredited school of nursing, with strong clinical case management experience
  • Three (3) years experience in Utilization Management/Case Management or related field, with specific experience in the following areas: the application of industry prevalent guideline criteria; knowledge of coding, billing, audit and reimbursement payer methodologies and guidelines. Experience in the collection, interpretation, and presentation of data to medical staff members; and, interaction with managed care companies, including appealing denials.
  • General:

  • Excellent written and verbal communication skills.
  • Ability to communicate effectively with business office, physicians, clinical care team and case management team.
  • Ability to type accurately at an approximate rate of 30 words per minute.
  • Work Hours:

    8am - 4:30pm

    Weekend Requirements:

    No

    On-Call Requirements:

    No

    Northside Hospital

    About Northside Hospital

    Northside Hospital — a certified Great Place To Work® — is one of Georgia’s top health systems. We have acute-care hospitals in Atlanta, Canton, Cumming, Duluth and Lawrenceville and hundreds of outpatient locations across the state. Northside Hospital leads the U.S. in newborn deliveries and is among the state’s top providers of cancer care, sports medicine, cardiovascular and surgical services.

    Industry
    Healthcare & Social Services
    Company Size
    10,000+ employees
    Headquarters
    Atlanta, GA
    Year Founded
    1970
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