RN Coordinator- Payor Audit/Full Time/Remote

GENERAL SUMMARY:

Under minimal supervision, this RN specializes in follow-up of denied and rejected claims from all commercial, contracted and non-contracted payers, including reviewing and preparing appeal letters. Working within a centralized department, reviews all medical necessity and coding related denials and appeal ability utilizing clinical judgment and applying appropriate medical necessity criteria. Provides clinical expertise to provide education, formal and informal and facilitates denial management strategies. Serves as a liaison to key customers that include, hospital ancillary departments, physicians, payers, and auditors.