Registered Nurse/RN, Clinical Denial Appeals

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Date posted: 10/09/2019

job description

Registered Nurse/ RN: Clinical Denials Appeals- Full-Time job, Albuquerque, NM

We are looking for a Registered Nurse, Clinical Denials Appeals to join our Albuquerque team.

This Full-Time job is located with   Lovelace Shared Services, organizational support departments for all Lovelace facilities including Coding, Finance, Health Information Management, Revenue Cycle, Marketing, and the Resource Team. We are dedicated to exceeding our customers’ expectations in every way.

  Lovelace Shared Services is hiring a Clinical Denial Appeals RN.

  • This position is to assess and utilize clinical and financial information. 
  • In partnership with patients, physicians, and other health care providers, this position will support utilization of resources and obtain optimal reimbursement to assure maximum appropriate reimbursement for the Organization.
  •   Participates in telephone clinical review and multi-disciplinary referrals regarding patient care coverage issues. 
  • Position identifies trends and disseminates as necessary for appropriate action. 
  •   Trains department and provides direction and to coders on how to improve coding to minimize over/undercharging by the departments. 
  •   All work processed by the incumbent is confidential. 
  •   Completes established competencies for the position within designated introductory period. 

  • Associate’s Degree or Diploma of Nursing
  • Desired: Bachelor’s Degree in Nursing
  • Five (5) years clinical nursing experience and Two (2) years managed care experience
  • Valid NM Nursing License or NM compact license (within 90 days of hire)
  • Current BLS
  • Must be able to work flexible hours
  • Knowledge of the operations of patient billing; the UB -04, the Itemized Statement, coding information reported on claim and grievance procedures. 
  • Demonstrated knowledge of the State Medicaid structure and other insurance plans (i.e., commercial, Medicare, HMO/PPOs, etc.)

Why Lovelace?

  • Named one of the 150 Great Places to Work in Healthcare by Becker’s Hospital Review
  • Named one of the Best Places to Work by Albuquerque Business First
  • Named Top Workplace by Albuquerque Journal, 2013, 2014 and 2015
  • Named to Modern Healthcare’s 100 Best Places to Work five times since 2008

Lovelace is a drug-free employer with smoke free campuses.

  ID: 2407



job facility

Business Office - Ardent Patient Financial Services

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.