Branch Review Specialist jobs in Clearwater, FL

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

Summary:

The Denials Specialist - Utilization Review is responsible for timely review of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity. Working closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members, the Denials Specialist - Utilization Review maintains and coordinates a timely appeal process or effectuates a correction of billing status. Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.

Minimum Qualifications:

Education and Experience:

Required - Associate degree in nursing and 4 years Utilization Review, Managed Care or Finance OR

Bachelors Degree in Nursing and 2 years Utilization Review, Managed Care or Finance

Preferred - Masters Degree in Nursing or MBA

2 years Case Management experience

6 months Denials Management experience

1 year Medicaid/Medicare experience

Required Registered Nurse

Preferred Accredited Case Manager OR

Certified Case Manager

Benefits:

• Benefits (Health, Dental, Vision)
• Paid time off
• Tuition reimbursement
• 401k match and additional yearly contribution
• Yearly performance appraisals and team award bonus
• Community discounts and more

BayCare Health System, Utilization and Denials Mgmt-MPH

Location: Morton Plant

Status: Full Time, Exempt: Yes

Shift Hours: Monday - Friday 7:00 AM - 3:30 PM

Shift: Shift 1

Shift 1 = Days, 2 = Evenings, 3 = Nights, 4 = Varies

Weekend Work: None

On Call: No

How often will this team member be working remotely? Hybrid

Equal Opportunity Employer Veterans/Disabled