Denials Management Specialist
Houston Methodista month ago
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OnsiteFull-timeSenior
Summary
Houston Methodist is seeking a Denials Management Specialist to join their team in Nashville, TN. The role involves reviewing, coordinating, and monitoring the clinical denial management and appeals process.
About the Role
As a Denials Management Specialist, you will collaborate with Central Business Office management and clinical partners to reduce financial risk from payment denials. Your responsibilities include reviewing denials for medical necessity, developing appeal strategies, and training staff on denial management processes. You will also analyze data to identify root causes of denials and implement strategies to prevent future occurrences.
About You
Required:
- Graduate of an education program approved by the credentialing body for the required credentials.
- Seven years of clinical nursing/patient care experience with five years in utilization review or equivalent revenue cycle clinical role.
- Experience with prior authorization processes.
Preferred:
- Bachelor of Science degree.
- CPHM - Certified Professional in Healthcare Management.
- CCM - Certified Case Manager.
- ACM - Accredited Case Manager or equivalent.
Benefits
- Comprehensive benefits package including medical, dental, and vision coverage.
- Opportunities for professional development and continuing education.
Houston Methodist
Houston Methodist is one of the nation’s leading health systems and academic medical centers. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care, emergency care and imaging centers; and outpatient facilities. Houston Methodist employs more than 32,000 people. Come lead with us.
Nashville, TN