Appeals Denial Management Lead

Additional Position Details: FTE: 1.0 | Full Time | Primarily Mon - Fri / 8AM - 5PM

Position Summary

The Appeals Denials Management Lead conducts medical necessity appeals and denial review as needed. In this role, the Lead serves as a resource and lead for the Appeals Team and as a subject matter expert for recovery audit contractors (RACs), TPEs, and other governmental audits/denials; collaborates with Physicians, Coders/Billers, Payer Contracting and other healthcare team members to offer root cause corrections to identified trends; and educates Physicians, CDI, Coders, ancillary department staff, case managers, and other members of the healthcare team on ways to mitigate and reduce denials.

Qualifications

Education

• Bachelor's degree in Nursing or related field within 6 months of hire is required.

Experience

• 2 years nursing experience in clinical practice areas such as acute care hospital, physician clinics, quality, case management, utilization review, performance improvement, informatics - PLUS at least one year experience in Appeals/Denials Management and/or Clinical Documentation Integrity (CDI) is required.
• Previous lead or supervisory experience preferred.

Licensure/Certifications

ONE of the following is required:

• RN: Registered Nurse licensed by the Oregon State Board of Nursing, or
• FMG (ECFMG): Foreign Medical Graduate certified by the Education Commission for Foreign Medical Graduates.

Preferred Education/Certifications

• Master's degree in Nursing or related field.
• Certified Clinical Documentation Specialist (CCDS) - OR - Certified Clinical Documentation Specialist - Outpatient (CCDS-O) through Association for Clinical Documentation Improvement Specialists (ACDIS).
• CCS: Certified Coding Specialist (AHIMA).
• CPC: Certified Professional Coder (AAPC).
• CCS-P: Certified Coding Specialist - Physician Based (AHIMA).
• CCM: Certified Case Manager.

What We Offer

• Progressive pay - including earning more with a preferred department-designated specialty certification and/or a preferred degree!
• Comprehensive Total Rewards package including medical, dental, vision, wellness; retirement plan with up to a 6% employer contribution; and a generous paid time off policy that increases with years of service.
• Tuition Reimbursement Program.

What We Offer Our Flexible Workforce (Per diem/On-call)

• Progressive nursing pay - including earning more with a preferred department-designated specialty certification and/or a preferred degree!
• An additional 15% on top of the base hourly rate (if not an employee already in a benefited position).
• Excellent retirement package with up to a 6% employer contribution.
• Benefit option available through the Asante Flexible Workforce plan.

Why Asante

Asante is more than a great hospital system in an amazing location. We are a community of passionate providers and service-focused caregivers who collaborate to deliver amazing patient outcomes; a place where titles don't matter as much as your creativity, drive, and passion. Our culture, values and people create an environment of sustained medical excellence.

More About Asante and Southern Oregon

Asante is a local, community owned and governed, not-for-profit organization that provides comprehensive health care services to more than 550,000 people in a nine-county area of Southern Oregon and Northern California. It includes Asante Ashland Community Hospital in Ashland, Asante Rogue Regional Medical Center in Medford, Asante Three Rivers Medical Center in Grants Pass, Asante Physician Partners throughout the Rogue Valley, and additional health care partnerships. Virtually all medical specialties and services are represented within an organization dedicated to providing exceptional care. With over 5,000 employees, Asante's entities offer outstanding opportunities for career advancement and professional growth. At Asante your work positively impacts your family, friends, neighbors, and the community. Experience the difference in how you work, how you live and how you connect.

At Asante we are defined by our values - traits that guide us as we serve patients and the community:

Excellence - Respect - Honesty - Service - Teamwork

Asante is an equal opportunity employer. We are committed to employ and advance in employment women, minorities, qualified individuals with disabilities and protected veterans.