Denial Prevention Clinical Coordinator RN in Las Vegas, Nevada, United States
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Sunrise Hospital

Denial Prevention Clinical Coordinator RN

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Description

SHIFT: No Weekends
SCHEDULE: Full-time
Salary Estimate: $68619.20 - $102918.40 / year
Learn more about the benefits offered for this job.

The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

For more than three decades, Sunrise Hospital in Las Vegas has been Nevada’s largest, most comprehensive children’s hospital dedicated to caring for infants, children, adolescents and expectant mothers. As the leading neonatal, pediatric, and maternal provider in the region, we partner with physicians and hospitals throughout the Southwest to offer the most comprehensive and advanced health programs as well as access to sub-specialties. Sunrise Children's Hospital provides advanced pediatric and neonatal medicine to the residents of Southern Nevada and the surrounding region. Located near the Las Vegas strip, Sunrise Children’s Hospital offers 24/7 pediatric emergency services in our ER just for kids. In addition to pediatric cardiology, Sunrise Children's Hospital also features Nevada's largest, most comprehensive 72-Bed Level III Neonatal Intensive Care Unit (NICU), 24-bed Pediatric Intensive Care Unit (PICU), and 14-bed inpatient pediatric Cardiac Intensive Care Unit (CICU), the only one of its kind in Nevada today. The CICU is a 12,000 square-foot unit dedicated to the treatment of congenital heart defects, heart rhythm disturbances and heart disease in infants and children.

As Las Vegas' largest acute care facility (762 beds), Sunrise provides sophisticated inpatient and outpatient services to the community.  Sunrise Hospital & Medical Center has been recognized with the following awards and accreditations:

  • Consumer Choice Award recipient for 15 consecutive years
  • Joint Commission Accredited
  • American Stroke Association Get with The Guidelines Gold Plus Performance Achievement Award
  • CARF Accredited Rehabilitation Unit
  • Nursing Professionals Top 100 Hospitals to Work For

Joinus as we achieve our Mission Statement:

Sunrise Hospital & Medical Center and Sunrise Children's Hospital are dedicated to providing an unparalleled level of measurable quality in the delivery of cost-effective, integrated healthcare services that are responsive to the needs of our patients, physicians, employees, and community.

We are committed to providing our employees with the support they need.  We offer an array of medical, dental, and vision packages as well as several add-on perks to make your benefits package truly customizable to you and your family needs. Some of our unique benefits we offer include:

    • Student Loan Forgiveness
    • Tuition Reimbursement/Assistance Programs
    • Paid Personal Leave
    • 401k (100% annual match – 3% to 9% of pay based on years of service)
    • Identity Theft Protection discounts
    • Auto, Home, and Life Insurance options
    • Adoption Assistance
    • Employee Stock Purchase Program (ESPP)

HCA is dedicated to the growth and development of our colleagues.  We will provide you the tools and resources you need to succeed in our organization.  We are currently looking for an ambitious Denial Prevention Clinical Coordinator to help us reach our goals.  Unlock your potential here!

POSITION SUMMARY:

Responsible for providing clinical review and analysis of concurrent denial prevention initiatives within the assigned facility.  Maintains a current working knowledge of non-governmental and governmental payers and contracted language.  Knowledge of payer trends and analysis of denials with a focus on prevention of denials within the acute setting.  Will assist with the identification of strategies for prevention and initiate processes for denial avoidance.  Monitors and provides detailed analysis of trends in the non-governmental sector.  Provides direction and support to the assigned facility with root cause analysis of received denials. Develops and implements action plans with interventions as needed with all facility departments.  Identifies education opportunities within the facility and assists with communication required for intervention.  Provides updates to developed reports/dashboards and communicates weekly with Facility Denials Prevention Lead, Division Denial Prevention Manager and facility CFO & Administrative Director of Case Management on all opportunities.  Responsible for immediate interventions to assist facility in prevention of denials.  Communicates appropriately with all relevant entities:  Facility, Division, SSC, PDU, Managed Care AVPs and Payers.

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply. We promptly review all applications. If you are highly qualified you will hear from one of our managers. Come unlock the possibilities and apply today!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Qualifications

MINIMUM QUALIFICATIONS

Education:

  • RN diploma/College Degree from an accredited school of nursing program
  • BSN preferred

License/Certification:

  • Current RN license in the state of Nevada
  • CCM or Utilization Review preferred

Experience:

  • Minimum 3 years in acute hospital setting with experience in Registration/Patient Accounting and Case Management  OR

  • Minimum 3 years experience directly working in the following:  Revenue Cycle activities, Collections and Appeals

  • Working knowledge of government and non-government payer practice regulation standards and reimbursement

  • Familiar with accreditation standards and compliance requirements

  • Denial/Appeal Management experience required in Commercial Managed Care/Governmental Insurances arena. 

  • Analytical skill set necessary. 

  • Excellent oral and written / interpersonal communication skills and Customer Service oriented.

Knowledge, Skills & Abilities:

  • Must be proficient in Excel program spreadsheets and other programs - MIDAS, Meditech, Artiva, On-Base

Notice

Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.

For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.

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About HCA Healthcare

What matters most to our diverse and talented colleagues is giving people the absolute best healthcare in the most compassionate way possible.

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For questions about your job application or this site, please contact:
HCAhrAnswers at 1-844-422-5627 option 1.

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