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Recovery Audit Contract Appeal RN: University Community Health

Across from the University of South Florida, you'll find University Community Hospital the flagship of University Community Health. This 431-bed facility is home to our six centers of excellence focusing resources on major disease areas including cancer treatment, cardiac care, women's health, pediatrics, diabetes management and orthopedics, and offer patients access to the most advanced technology and treatment options. Although we employ a staff of over 3,000 and provide the expertise of nearly 900 physicians and more than 50 different specialties, we strive to maintain a family atmosphere.

In addition, University Community Hospital offers several specialized service units including intensive care, pediatric/neonatal intensive care, rehabilitation, occupational health, continuing care and orthopedic, pediatric and general surgery as well as a 24-hour emergency department with dedicated treatment facilities for chest pain, pediatrics and minor care.


Responsible for coordinating and conducting all RAC appeals referred by the RAC Supervisor and Account Representatives. Initiates the appeal process & facilitates overturning denied claims within the allowed time frames set forth by CMS guidelines and the Managed Care payer contracts. Demonstrates knowledge of payer contracts and provides clinical information in order to overturn denials and ensure optimum reimbursement is obtained. Will provide input and guidance to departments within Patient Business Services to assist in getting claims paid. Assists as needed with Case Management, nursing, admitting and provides support to the CBO appeals nurse in conducting Managed Care appeals, and other duties as assigned.

Requirements include:

1. BSN
2. Current FL License as Registered Nurse.
3. Minimum of 3 years relevant experience with preference given to those candidates who have worked in both payor and provider organizations.

Required Knowledge, Skills and Abilities:

Individuals must possess these knowledge, skills and abilities and be able to explain and to demonstrate that s/he can perform the essential functions of the job, with or without reasonable accommodation, using some other combination of skills and abilities.

1. RN Clinical background strong communication skills, both oral and written, sufficient to communicate complex issues and essential concepts to technical and non-technical personnel.
2. A demonstrated comprehension of legal and clinical terms as they relate to managed care contracting, payment compliance, financial, information systems and managed care principles and practices, with substantial knowledge of business concepts and terminology specific to the health care industry. Strong functional knowledge and broad multi-functional knowledge of healthcare delivery.
3. Demonstrated organization skills with the ability to prioritize and coordinate multiple tasks. Ability to work under pressure in a fast paced environment with changing priorities.
4. Exercises independent judgment and discretion in performing tasks.
5. Proven financial and analytical skills with the ability to applying excellent interpersonal and technical skill to resolve complex situations where information gaps and ambiguity are the norm.



At University Community Health, we are dedicated to providing outstanding patient care. That is why our mission is to recruit and retain the best employees. We offer comprehensive benefits, a competitive wage program and a team of dedicated employees. Join our team of expert healthcare professionals! EOE. Drug Free Workplaces. Accredited by the Joint Commission.

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