Job Description

Clinical Denial Appeals Registered Nurse (RN), Patient Financial Services, Full-time, Days, Albuquerque, NM. We are looking for a Clinical Denial Appeals RN to join our Patient Financial Services team, in Albuquerque NM. This position is remote or office based. This full-time job is located at Lovelace Central Business Offices in Albuquerque: Organizational Position supports facilities for all Lovelace, Hillcrest & University of Kansas hospitals. We are dedicated to exceeding our customers’ expectations in every way. Registered Nurse (RN) Clinical Denial Appeals Job Responsibilities: This position is to assess and utilize clinical and financial information to effectively appeal claim denials after service is provided related to Level of Care, Medical Necessity & continued authorization related to IP and OBS claims. Ability to effectively write appeals with all required information needed to overturn denials. Must be able to work flexible hours, at the ABQ office or remotely. In partnership with patients, physicians, and other health care providers, this position will support utilization of resources and obtain appropriate & optimal reimbursement to assure maximum appropriate reimbursement for the organization. Position identifies trends and disseminates as necessary for appropriate action All work processed by the incumbent is confidential. Completes established competencies for the position within designated introductory period. Other related duties as assigned. Registered Nurse (RN) Clinical Denial Appeals Education and Experience Job Requirements: Minimum: Associate’s Degree or Diploma of Nursing Desired: Bachelor’s Degree in Nursing 5 years clinical nursing experience and two years managed care experience. Knowledge of the operations of patient billing; the UB -04, the Itemized Statement, coding information reported on claim and grievance procedures. Demonstrated knowledge of the State Medicaid structure and other insurance plans (i.e., commercial, Medicare, HMO/PPOs, etc.) Valid NM Nursing license or NM compact license (within 90 days of hire) BLS; HIRING DEPARTMENT MAY ALSO REQUIRE ACLS and or PALS. Why Lovelace? New Mexico Family Friendly Business Award – Tier 1, 2016-2019 Lovelace is a drug-free employer with smoke free campuses. more