Denial Resource Center RN (Hybrid)

Company: Baylor Scott & White Health
Location: Dallas
Posted on: May 24, 2025

Job Description:

About UsHere at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers 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.Job SummaryYou, 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.Candidates MUST Either Have
  • Appeal writing experience for a Health System or Hospital.
  • Worked on the payer (Insurance) side of appeals and denials.
  • Experience in Utilization Review and Case Management.Essential Functions Of The Role
    • 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.Key Success Factors
      • 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.BenefitsOur benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:
        • Eligibility on day 1 for all benefits
        • Dollar-for-dollar 401(k) match, up to 5%
        • Debt-free tuition assistance, offering access to many no-cost and low-cost degrees, certificates and more
        • Immediate access to time off benefitsAt Baylor Scott & White Health, your well-being is our top priority.Note: Benefits may vary based on position type and/or levelBelonging StatementWe believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve.Qualifications
          • Associate degree.
          • A minimum of (2) two years of relevant work experience is preferred.
          • Applicants should be registered nurses.

Keywords: Baylor Scott & White Health, Tyler , Denial Resource Center RN (Hybrid), Healthcare , Dallas, Texas