Denial Prevention Nurse Consultant

Revecore

Location: New York City, New York, USA

Category: Healthcare

Salary: 60,000 - 80,000 USD / yearly

Full-time

Job Description

Join Revecore as a Denial Prevention Nurse Consultant and be responsible for reviewing medical records, validating services, and preparing appeals for payment based on medical necessity. This role involves analyzing denials, communicating with insurance companies, and providing best practice recommendations to clients.

Responsibilities

Build strong relationships with clients, payors, and Revecore personnel
Analyze medical records for billing accuracy
Research payor policies and appeal denied claims
Contact insurance companies to resolve underpayments and denials
Prepare and submit correspondence related to claims
Perform denial trending and provide best practice recommendations
Maintain confidentiality of information
Lead client meetings and consulting services

Qualifications

RN with clinical nursing experience
Minimum 5 years of utilization review or patient accounting experience
Proficiency with Interqual and MCG guidelines
Knowledge of patient accounting documents and Microsoft Office
Strong analytical and problem-solving skills
Experience with healthcare billing software

Perks & Benefits

Paid training and incentive plans
Medical, dental, vision, and life insurance benefits available from day one
Work/life balance
401(k) contributions matching
Career growth opportunities
12 paid holidays and generous time off

Why Join Us?

Revecore offers a collaborative and diverse culture with great work/life balance. Join us to make a meaningful impact on hospitals from the comfort of your home.