About Us

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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.

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Our Core Values are:

\n\nWe serve faithfully by doing what's right with a joyful heart.\nWe never settle by constantly striving for better.\nWe are in it together by supporting one another and those we serve.\nWe make an impact by taking initiative and delivering exceptional experience.\n\n

Job Summary

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You, 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.

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Candidates MUST either have:

\n\nAppeal writing experience for a Health System or Hospital.\nWorked on the payer (Insurance) side of appeals and denials.\nExperience in Utilization Review and Case Management.\n\n

Essential Functions of the Role

\n\nYou receive rejected healthcare claims from financial office or provider. You appeal until resolution following guidelines.\nReviewing medical records is important. Verify care levels, admissions, and hospitalizations. Evaluate stay duration and discharge planning.\nYou will contribute to improving processes and protocols by identifying opportunities for enhancement and earnestly participating in their implementation.\nBy closely examining denial trends, you will categorize them based on impacts like diagnosis, type and procedural variations amongst others.\nYou will record denial data and appeal findings in an electronic system. The system helps study denial trends and assess appeal outcomes.\n\n

Key Success Factors

\n\nAwareness and knowledge of nursing procedures and patient care standards.\nExcellent ability in problem-solving and critical thinking.\nHighly capable of clear communication, both spoken and written.\nCapability to engage meaningfully with varied groups of people.\nAbility to carefully observe patients' condition changes and communicate effectively with nursing staff and providers.\n\n

Benefits

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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:

\n\nEligibility on day 1 for all benefits\nDollar-for-dollar 401(k) match, up to 5%\nDebt-free tuition assistance, offering access to many no-cost and low-cost degrees, certificates and more\nImmediate access to time off benefits\n\n

At Baylor Scott & White Health, your well-being is our top priority.

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

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Belonging Statement

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We 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.