RN - Appeals - Revenue Cycle - 4S Ranch/Hybrid

Scripps Health
United States, California, San Diego
Nov 22, 2024
Description This is a Full-Time position with a Monday-Friday schedule. Business hours are 7am to 3:30pm. No holidays or weekends required. Position is hybrid. Requires 1 day on-site at 4S Ranch and 4 days remote. Must be local to San Diego. Join the Scripps Health team and work alongside passionate caregivers and provide patient-centered healthcare. Receive endless appreciation while you build a rewarding career with one of the most respected healthcare organizations nationwide. Why join Scripps Health? AWARD-WINNING WORKPLACE: Fortune Best Workplaces in Health Care 2023 2023 PEOPLE Companies that Care Fortune 100 Best Companies to Work for 2023 Recognized by Newsweek as one of America's Greatest Workplaces for Diversity in 2024 Nearly a quarter of our employees have been with Scripps Health for over 10 years. We invite you to join our Revenue Cycle team as a Registered Nurse of Appeals. In this role, you will be responsible for the following... Review and management of assigned cases for utilization review and system reimbursement. Responsible for completing government and commercial appeals for systemwide hospital billing. Understands basic denial rationales and identifies primary denial issue. Provides well written appeal arguments based on clinical evidence within the medical record and evidence-based literature. Participates in the coordination and completion of regulatory audits. Utilizes critical thinking, interpersonal and technical skills in data collection and denial management. Qualifications Preferred Education/Experience/Specialized Skills/Certification: BSN preferred. Certification in UR/UM or CM preferred. Previous UM, Discharge Planning, or Case Management experience is preferred. Understanding of financial reimbursements, state and federal insurance programs, and the revenue cycle is strongly recommended. Clinical documentation integrity experience preferred. Required Education/Experience/Specialized Skills: Graduate of an accredited RN Program. Three to five years recent clinical experience in a variety of settings. Knowledge of InterQual and Milliman criteria. Ability to manage multiple tasks within regulatory agency time frames required. Strong computer skills including spreadsheet and data base management. Required Certification/Registration: Current RN license issued by the state of California. Job : RN Primary Location : Central San Diego County-SAN DIEGO-SCRIPPS CORPORATE OFFICES Work Locations : SCRIPPS CORPORATE OFFICES 4555 EXECUTIVE DR SAN DIEGO 92121 Organization : Scripps Health Corp Job Posting : Nov 22, 2024, 9:18:27 PM Benefit Status : FT - FULL-TIME WITH BENEFITS Minimum Rate (USD) : 55.35 - Maximum Rate (USD) : 82.10 In compliance with the California Pay Transparency Act, Scripps Health posts the pay range for all jobs. Please note that actual pay will be determined based on relevant experience and internal equity within the pay range. Please also note this range is applicable for employees who reside in California only. A geographical pay differential may be applied for remote employees who reside out of state. Scripps Health strives to ensure that our employees receive equal pay for equal work in line with our commitment to being an equal opportunity employer. Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.