Job Information

Kindred at Home Registered Nurse Denials Management Specialist in Dallas, Texas

Registered Nurse Denials Management Specialist

Registered Nurse

Dallas, TX

  • ID:72805

  • Full-Time/Regular

This is a remote opportunity and has been posted in multiple cities for one opening.

Our Care Matters.

When you join the Kindred at Home team, you become part of something bigger. We are the nation’s leading provider of comprehensive home health, hospice, and non-medical home care services. Our team delivers compassionate, high-quality care to patients in their homes or places of residence, including non-medical personal assistance, skilled nursing, rehabilitation, hospice and palliative care. Now more than ever, people in your community need in-home healthcare. Our team helps to keep them safely at home, during moments that matter most to them. Our caregivers focus on each unique patient to deliver the appropriate care and emotional support to our patients and their families.

Our Employees Matter.

We believe a world-class patient experience is enabled by an exceptional employee experience. And, committed to fostering an amazing employee experience at Kindred at Home. Our people are our greatest resource and asset, and we are committed to helping our employees thrive and fulfill their personal and professional goals.

We offer:

  • Competitive pay and 401k

  • Healthy Steps Wellness

  • Healthcare Plans

  • Employee Assistance Program

  • Centers of Excellence Program

  • Educational Assistance

  • Clinical ladder for professional credentialing and advancement

  • Leadership development

  • Talent focused Framework

  • Targeted personal and career development planning

Denials Management Specialis t is responsible to respond to, monitor and analyze all governmental requests, including but not limited to ADR’s, CERTS, RAC’s, ZPIC’s, SMRC’s, and all other revenue-driven denials and requests. Guides and coordinates with the branch staff in developing responses. Identifies the need for changes in policies, procedures, documentation strategies, and protocols based on regulatory requirements and makes recommendations as indicated.

Essential Functions:

  • Responsible for responding to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and ensure timely response to payer requests for additional documentation.

  • Monitors denials, collaborates with branch and billing staff to determine appropriate response, manages appeals process.

  • Monitors and responds to all requests related to revenue recovery including but not limited to Government and private payer requests.

  • Collaborates with branch and billing department staff to develop appropriate and timely responses.

  • Responsible for constructing response to denials and appeals, utilizing any federal guidelines or local coverage determination guidelines that are applicable to the record and response.

  • Monitors the development, interpretation and implementation of federal and governmental regulations. Coordinates the dissemination of information.

  • Provides trended reports for operations and clinical management in order to improve performance, collaborates with and acts as a resource for division and field support staff in identifying areas in need of attention/improvement.

  • Identifies the need for new and revised policies and training based on trends, changes in regulations, operations or clinical programs.

  • Participates in project team activities, and serves as a backup to divisional regulatory staff on issues of regulations, coverage, compliance and documentation.

  • Reviews records and operations as requested regarding compliance with policy and payer requirements.

  • Responsible for assigned tasks inside MAVEN: entering, tracking, uploading records, etc.

  • Participates in and provides training as assigned.

  • Performs other related duties as assigned or requested.

Required Skills

  • Registered Nurse.

  • Bachelor's Degree preferred.

  • Current state license as a Registered Nurse.

  • Current CPR certification preferred.

  • Current driver’s license.

  • Must have reliable transportation and insurance.

  • 5 years of professional experience in Home Care or Hospice, 2 of which are in an administrative, supervisory, or teaching position in/or related to a Medicare certified home health agency or hospice agency.

  • A thorough knowledge of federal regulations and Medicare requirements is required along with analytical skills to interpret and apply regulatory requirements.

  • Extensive knowledge of home care operations, compliance requirements and legal issues in home care.

  • Extensive experience in working with Payer requirements, ADR requests, Denials, Appeals, RAC, ZPIC, CERT, etc. responses.

  • Excellent written and verbal communications skills.

  • Must be able to multi-task and work well under pressure.

  • Must be able to learn Homecare Homebase, KindredLink and the MAVEN system quickly and extensively.

  • Must be proactive, responsive and resourceful.

  • Highly flexible and motivated with an ability to work independently as well as in a team setting.

  • Must consistently demonstrate the highest level of professionalism and discretion.

  • Ability to work a flexible schedule and extended hours on occasion in order to meet deadlines and/or work on special projects.

  • Requires working under some stress conditions to meet deadlines and agency needs.

  • Must read, write and speak fluent English.

Required Experience

Join Our Team!

Check out our video to get a glimpse of a day in the life of our Home Health team - Home Health

To learn more, please apply online. Our Recruiters are ready to help you start a new and rewarding career with Kindred at Home.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or national origin.

This position is located in Dallas, TX. View the Google Map in full screen.

Job Category: Registered Nurse