Location: UC Health- Remote Department: Denial Hours: Full Time 40 hr/week Shift: First UC Health is hiring a Full Time Registered Nurse (RN) for the Denials-Charge Audits for the first shift. This is a remote position. About University of Cincinnati Medical Center As part of the Clifton Campus of UC Health, Greater Cincinnati's academic health system, University of Cincinnati Medical Center has served Greater Cincinnati and Northern Kentucky for nearly 200 years. Each year, hundreds of thousands of patients receive care from our world-renowned clinicians and care team. Our experts utilize the most advanced medical knowledge and technology available, providing a level of specialty and subspecialty medical care that is not available anywhere else in Greater Cincinnati. UC Medical Center is also home to medical breakthroughs- our physician experts conduct basic, translational and clinical research, leading to new therapies and care protocols, and connecting patients to the latest and most advanced treatments. UC Medical Center houses Greater Cincinnati's only Level I adult trauma center, which includes the right mix of specialist and medical resources available at a moment's notice for a wide variety of the most complex medical conditions and injuries.Minimum Required: Associate's Degree - RN, Other: Diploma Nurse Preferred Degree: Bachelor's Degree - RN Minimum Required: 3 - 5 Years equivalent experience. Preferred: 6 - 10 Years equivalent experience. Hours: Full time 40 hr/week Shift: First Join our team as a Registered Nurse (RN) in our Psychiatry department and work alongside the best and brightest clinical teams collaborating toward our common purpose: to advance healing and reduce suffering. Join our team to BE UC Health. Be Extraordinary. Be Supported. Be Hope. Apply Today! About UC Health UC Health is an integrated academic health system serving Greater Cincinnati and Northern Kentucky. In partnership with the University of Cincinnati, UC Health combines clinical expertise and compassion with research and teaching-a combination that provides patients with options for even the most complex situations. Members of UC Health include: UC Medical Center, West Chester Hospital, Daniel Drake Center for Post-Acute Care, Bridgeway Pointe Assisted Living, University of Cincinnati Physicians and UC Health Ambulatory Services (with more than 900 board-certified clinicians and surgeons), Lindner Center of HOPE and several specialized institutes including: UC Gardner Neuroscience Institute and the University of Cincinnati Cancer Center. Many UC Health locations have received national recognition for outstanding quality and patient satisfaction. Learn more at uchealth.com.The Denials Management (DM) nurse will use established criteria and policies/procedures to perform reviews on denied accounts. Utilizing knowledge of utilization management regulations, registration, claims, and payor policies the Denial Management nurse will work assigned accounts to maximize reimbursement for the organization.

Contacts payors, as necessary, to inquire about denial reasons/rationale

Contacts UR staff, insurance verification, billing, coding, CDM, and physicians for clarification or to correct errors that are causing claims to deny

Discusses high-dollar denials with leadership, when necessary, for guidance on appeal criteria and prior to sending for write-off

Reviews all elements of denied accounts including registration, authorization, and medical necessity to identify the focus for appeal. Identifies accounts that need contractual adjustments or rebilling and sends to the appropriate department for correction

Utilizes InterQual or MCG criteria, base