Job Code: 26425-130395
Parallon Business Performance Group has the following Full Time opportunity available with the Richmond Shared Services Center, 7300 Beaufont Springs Drive, Richmond, Virginia.
Nurse Prebill Denial
The applicant must be an RN with current state licensure. You must be able to accommodate a Monday thru Friday work schedule, from 8:30AM to 5:00PM.
The Prebill Denial Nurse will perform activities focused on assessing medical necessity on patient accounts using approved clinical criteria to evaluate medical necessity, admission status, level of care assignments, etc. The Prebill Denial Nurse will be responsible for identifying and obtaining required authorizations, communicating with and accurately documenting all communications with third party payers in accordance with policies and procedures.
The applicant must:
Have three years of nursing experience in acute care setting
Experience/Certification in Case Management or Utilization Review is preferred
RN with current state licensure
Perform and communicate all utilization review activities to third party payers at defined intervals per payer requirements and/or facility policy
Establish and maintain collaborative and effective working relationships
Communicate effectively in oral, written and electronic formats
Possess an ability to demonstrate competency in applying clinical criteria
Communicate effectively and professionally with physicians, hospital staff and outside agencies
Education: Degree preferred
Experience: Utilization review, appeals, denials, managed care contracting preferred
We offer a convenient location, free parking, training support, competitive compensation, and excellent benefits that include several insurance packages to choose from, paid time off for vacation, sick leave and holidays, company matching 401K.
Parallon is an Equal Opportunity Employer (EOE), minority/Female/Veteran/Disabled, offering a great work environment, challenging career opportunities, and competitive compensation.
Last Edited: 05/25/2017