Description

About Us Here 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.

Benefits Our 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:

• Immediate eligibility for health and welfare benefits

• 401(k) savings plan with dollar-for-dollar match up to 5%

• Tuition Reimbursement

• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Job Summary Are you seeking an impactful job? Consider becoming a Supervisor for the Denial Resource Center. You will oversee medical claim appeals with a team. Ensure fair distribution and efficient operations. This role allows you to influence recommendations that impact patient care.

Essential Functions of the Role

• Manage nursing and administrative staff. Assign tasks, review productivity levels. Keep Denial Resource Center running smoothly.

• Carry out quality checks, provide guidance in peer-to-peer appeals as well as denial discoveries.

• Review timelines and work assignments and prioritize important tasks and specific cause accounts.

• Contribute your suggestions to enhance quality improvement measures in our center.

• Assist in the orientation and ongoing training of newly joined staff members.

• Review cases for possible external appeals, like ALJ, Texas HHSC, and VA complaints. You may also write clinical appeals.

• Act as a go-to resource for staff members when dealing with complicated accounts.

• Work with team members to evaluate and improve work process efficiency, focusing on account transitions and communication.

• Be a resource for IT matters and using key systems in the Denial Resource Center.

• Generate reports as needed for internal use and external partners. Utilize tools to track account status.

Key Success Factors

• This position demands nursing knowledge.

• Communication skills are essential.

• Interact with a variety of people.

• Critical thinking skills are necessary.

• Organize and guide your team strategically.

• Having an Accredited Case Manager or a Certified Case Manager license is highly valued but not mandatory.

Belonging Statement We believe that all people should feel welcomed, valued and supported.

Qualifications

• Associate's degree in Nursing.

• A minimum of (3) three years of relevant work experience.

• Must be a registered nurse (RN).

• Hybrid expectation- on-site as needed (mainly remote)