POSITION PURPOSE AND SUMMARY:

Under the direction of the Director of Utilization/Case Management/Social Service, the Denials Resolution Specialist reviews, appeals, advises, and collaborates with the medical staff in the resolution of treatment and services denied by Medicare, Medicaid, Tricare, commercial payers, and Managed Care organizations throughout the Powers Healthcare System.  

EDUCATION/EXPERIENCE:

Registered Nurse with a Bachelor’s degree in nursing preferred. Relevant professional certification (certified coder, etc.) highly desirable. Three years minimum of successful experience in provider reimbursement. Two years recent experience in and acute care hospital setting.