Submission for the position: Denial Resource Center RN (Hybrid) - (Job Number: 24011456)

About Us

At Baylor Scott & White Health, we support well-being for people, families, and communities. It is Texas' largest not-for-profit healthcare system. They empower you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our competitive benefits package empowers you to live well and provides:

• Eligibility on day 1 for all benefits
• Dollar-for-dollar 401(k) match, up to 5%
• Debt-free tuition assistance, offering acce
  
  to many no-cost and low-cost degrees, certificates and more
• Immediate access to time off benefits

At Baylor Scott & White Health, your well-being is our top priority. Visit BSWHealth.com/Benefits to learn about all of our programs that supports mind, body and spirit

Note: Benefits may vary based on position type and/or level

Job Summary

You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health, manage denials and appeals. Your job is to handle claim denials from all insurance companies, addressing various reasons.

What You'll Do

• You receive rejected healthcare claims from financial office or provider. You appeal until resolution following guidelines.
• Reviewing medical records is important. Verify care levels, admissions, and hospitalizations. Evaluate stay duration and discharge planning.
• You will contribute to improving processes and protocols by identifying opportunities for enhancement and earnestly participating in their implementation.
• By closely examining denial trends, you will categorize them based on impacts like diagnosis, type and procedural variations amongst others.
• You will record denial data and appeal findings in an electronic system. The system helps study denial trends and assess appeal outcomes.

What Will Make You Successful In The Role

• Awareness and knowledge of nursing procedures and patient care standards.
• Excellent ability in problem-solving and critical thinking.
• Highly capable of clear communication, both spoken and written.
• Capability to engage meaningfully with varied groups of people.
• Ability to carefully observe patients' condition changes and communicate effectively with nursing staff and providers.

Belonging Statement

We want everyone to feel valued and supported, and our workforce should mirror the communities we serve.

Qualifications

• Associate degree.
• A minimum of (2) two years of relevant work experience is preferred.
• Applicants should be registered nurses.