Branch Review Specialist conducts branch internal audits to determine whether business controls are sufficient and effectively executed in accordance with bank policies and procedures. Tests established procedures to ensure operational efficiency within branch offices. Being a Branch Review Specialist determines whether branches are performing their planning, accounting, custodial, or business control activities in compliance with management instructions, policies, and procedures. Evaluates functions and activities in assigned areas to determine the nature of operations and the adequacy of systems to achieve established objectives. Additionally, Branch Review Specialist recommends corrective actions and improvements. Requires a bachelor's degree. Typically reports to a supervisor or manager. The Branch Review Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Branch Review Specialist typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)
At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.
Summary:
The Denials Specialist - Utilization Review is responsible for timely review of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity. Working closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members, the Denials Specialist - Utilization Review maintains and coordinates a timely appeal process or effectuates a correction of billing status. Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.
Minimum Qualifications:
Education and Experience:
Required - Associate degree in nursing and 4 years Utilization Review, Managed Care or Finance OR
Bachelors Degree in Nursing and 2 years Utilization Review, Managed Care or Finance
Preferred - Masters Degree in Nursing or MBA
2 years Case Management experience
6 months Denials Management experience
1 year Medicaid/Medicare experience
Required Registered Nurse
Preferred Accredited Case Manager OR
Certified Case Manager
Benefits:
BayCare Health System, Utilization and Denials Mgmt-MPH
Location: Morton Plant
Status: Full Time, Exempt: Yes
Shift Hours: Monday - Friday 7:00 AM - 3:30 PM
Shift: Shift 1
Shift 1 = Days, 2 = Evenings, 3 = Nights, 4 = Varies
Weekend Work: None
On Call: No
How often will this team member be working remotely? Hybrid
Equal Opportunity Employer Veterans/Disabled
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