Registered Nurse (RN) - Clinic
Penn State Health Milton S. Hershey Medical Center
Hershey, PA

Clinical Appeals Nurse (Clinical Documentation / Clinical Validation Reviews)

Penn State Health - Penn State Health Corporation Location: US:PA:Hershey Work Type: Full Time FTE: 1.00 Shift: Day Hours: 8:00a - 4:30p flexible Recruiter Contact: Garrett C. Kieffer at [email protected] 100% Remote Position SUMMARY OF POSITION: The clinical appeals nurse will be responsible for reviewing all clinical validation/DRG denials for the Penn State Health Community Hospitals. This will include all Pre-pay and Post-pay audit denials. The appeals nurse will subsequently draft any required appeals until the process is completed. Review denied cases (Real time, retro and audit denials) that jeopardize reimbursement to determine a plan of action for appeal or acceptance based on medical necessity. Compose appeal letters in an effort to overturn insurance denials. This position will specifically focus on the review of Clinical Validation Audits. MINIMUM QUALIFICATION(S): * Bachelor's degree in Nursing required. * Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate RN license through the interstate Nurse Licensure Compact. PREFERRED QUALIFICATION: * Experience in Clinical Documentation. WHY PENN STATE HEALTH? Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community. For more information: https://this.pennstatehealth.org/#thisIsPennStateHealth Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below: * Be Well with Employee Wellness Programs, and Fitness Discounts (University Fitness Center, Peloton). * Be Balanced with Generous Paid Time Off, Personal Time, and Paid Parental Leave. * Be Secured with Retirement, Extended Illness Bank, Life Insurance, and Identity Theft Protection. * Be Rewarded with Competitive Pay, Tuition Reimbursement, and PAWS UP employee recognition program. * Be Supported by the HR Solution Center, Learning and Organizational Development and Virtual Benefits Orientation, Employee Exclusive Concierge Service for scheduling. For a full list with more detailed information: https://www.pennstatehealth.org/careers/working-here/total-rewards This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities. Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person's perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information. If you are unable to use our online application process due to an impairment or disability, please call 717-531-8440 between the hours of 7:30 AM and 4:30 PM, Eastern Standard Time, Monday through Friday, email [email protected] or download our Accommodation Instructions for Job Applicants PDF for more detailed steps for assistance. Apply now Internal Employees - Apply