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Remote Registered Nurse Denials Management Specialist

Company: ???????Kindred at Home
Location: Dallas
Posted on: November 26, 2022

Job Description:

* This is a remote position and can be based anywhere in the United States.*

The Denials Management Specialist is responsible to respond to, monitor and analyze all governmental requests, including but not limited to ADR's, CERTS, RAC's, ZPIC's, SMRC's, and all other revenue-driven denials and requests. Guides and coordinates with the branch staff in developing responses. Identifies the need for changes in policies, procedures, documentation strategies, and protocols based on regulatory requirements and makes recommendations as indicated.

Essential Functions:

* Responsible for responding to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and ensure timely response to payer requests for additional documentation.

* Monitors denials, collaborates with branch and billing staff to determine appropriate response, manages appeals process.

* Monitors and responds to all requests related to revenue recovery including but not limited to Government and private payer requests.

* Collaborates with branch and billing department staff to develop appropriate and timely responses.

* Responsible for constructing response to denials and appeals, utilizing any federal guidelines or local coverage determination guidelines that are applicable to the record and response.

* Monitors the development, interpretation and implementation of federal and governmental regulations. Coordinates the dissemination of information.

* Provides trended reports for operations and clinical management in order to improve performance, collaborates with and acts as a resource for division and field support staff in identifying areas in need of attention/improvement.

* Identifies the need for new and revised policies and training based on trends, changes in regulations, operations or clinical programs.

* Participates in project team activities, and serves as a backup to divisional regulatory staff on issues of regulations, coverage, compliance and documentation.

* Reviews records and operations as requested regarding compliance with policy and payer requirements.

* Responsible for assigned tasks inside MAVEN: entering, tracking, uploading records, etc.

* Participates in and provides training as assigned.

* Performs other related duties as assigned or requested.

Required Experience/Skills:

* Registered Nurse.

* Bachelor's Degree preferred.

* Current state license as a Registered Nurse.

* Current CPR certification preferred.

* Current driver's license.

* Must have reliable transportation and insurance.

* 5 years of professional experience in Home Care or Hospice, 2 of which are in an administrative, supervisory, or teaching position in/or related to a Medicare certified home health agency or hospice agency.

* A thorough knowledge of federal regulations and Medicare requirements is required along with analytical skills to interpret and apply regulatory requirements.

* Extensive knowledge of home care operations, compliance requirements and legal issues in home care.

* Extensive experience in working with Payer requirements, ADR requests, Denials, Appeals, RAC, ZPIC, CERT, etc. responses.

* Excellent written and verbal communications skills.

* Must be able to multi-task and work well under pressure.

* Must be able to learn Homecare Homebase, KindredLink and the MAVEN system quickly and extensively.

* Must be proactive, responsive and resourceful.

* Highly flexible and motivated with an ability to work independently as well as in a team setting.

* Must consistently demonstrate the highest level of professionalism and discretion.

* Ability to work a flexible schedule and extended hours on occasion in order to meet deadlines and/or work on special projects.

* Requires working under some stress conditions to meet deadlines and agency needs.

* Must read, write and speak fluent English.

* This role requires full COVID-19 vaccination

Who we are

Together, we can raise the bar on home healthcare

CenterWell--- Home Health (formerly Kindred at Home), is one of the nation's leading providers of home care, with an incredible team of compassionate clinicians who deliver high-quality, specialty care to patients. Many of our clinicians live in the same neighborhoods they serve - providing the much-needed care to people in their community.

As a company, we strive to lead by example and show employees the same compassion and care we expect them to show patients. We provide employees the resources, stability, and job flexibility they truly deserve. We help them fulfill their personal and professional goals while enjoying industry-leading benefits, competitive salaries, opportunities for career and professional growth, and a healthy work/life balance.

Part of Humana's Home Solution business

CenterWell Home Health cares for nearly 80,000 patients every day in over 350 locations, across 38 states. As part of Humana Inc., we create experiences that put patients at the center, working in collaboration with healthcare providers to bring multidisciplinary care directly to the comfort and safety of home. The result is easy, comprehensive and personalized care that helps patients lead healthier, happier lives.

Caring for people who care for our patients

Experience has shown us that supporting and nurturing employees helps them become the best version of themselves and more compassionate, committed home health professionals. That's why CenterWell Home Health never stops working to improve the employee experience. Our people are our greatest resource, and we are committed to creating an environment they enjoy stepping into every day.

World-class employee benefits

* Competitive pay and benefits package

* 50% matching 401(k) contributions up to 6%

* Career advancement opportunities

* Tuition reimbursement program

* Advanced Continuing Education (CE) accredited training

We have careers near you

Join Our Team!

Check out our video to get a glimpse of a day in the life of our Home Health team - Home Health

To learn more, please contact your local recruiter at (toll-free) 855-563-2846 or apply online. Our Recruiters are ready to help you start a new and rewarding career with CenterWell Home Health.

Keywords: ???????Kindred at Home, Dallas , Remote Registered Nurse Denials Management Specialist, Healthcare , Dallas, Texas

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