LPN - Clinical Denials Specialist

Shift: 30 hours/week. Monday – Friday, variable hours between 7am – 5:30pm. One weekend/month

Work Arrangement: Hybrid
Department: Utilization Management

Facility: Quarterdeck Building – 2401 Lemone Industrial Blvd, Columbia, MO
Compensation:

·        Base Pay Range: $22.14 - $34.59 per hour, based on experience

ABOUT THE JOB

MU Health Care is looking for a detail-oriented LPN - Clinical Denials Specialist who is passionate about improving processes, solving complex challenges, and protecting the financial health of our organization. The ideal candidate is a proactive problem-solver with strong communication skills who enjoys collaborating with clinical teams, physicians, and revenue cycle leaders to identify and resolve claim denial issues. In this impactful role, you will investigate payer denials, manage authorization-related challenges, analyze trends, and uncover opportunities to enhance reimbursement outcomes. We value professionals who can think critically, identify root causes, and drive meaningful improvements that reduce denials and support operational excellence. Join MU Health Care and play a key role in advancing efficient, patient-centered care while helping ensure the resources needed to serve our communities remain strong.

ABOUT MU HEALTH CARE

MU Health Care is proud to be named one of Forbes’ Best-in-State Employers seven years in a row, and that’s largely a result of the incredible culture and team we’ve built. At MU Health Care, we have an inspired, hard-working and collaborative environment driven by our mission to save and improve lives. Here, we believe anything is possible and rally around solutions. We celebrate innovation and offer opportunities to be a part of something bigger — to have a voice and role in the work that is serving our community and changing the field of medicine.

Our academic health system — the only in mid-Missouri — is home to seven hospitals, including the region’s only Level 1 Trauma Center and region’s only Children’s Hospital, as well as over 90 specialty clinics. Here you can define your career among our many clinical and nonclinical positions — with growth, opportunity and support every step of the way.

Learn more about MU Health Care.

Learn more about living in mid-Missouri.

EMPLOYEE BENEFITS

·        Health, vision and dental insurance coverage starting day one 

·        Generous paid leave and paid time off, including ten holidays 

·        Multiple retirement options, including 100% matching up to 8% and full vesting in three years

·        Tuition assistance for employees (75%) and immediate family members (50%) 

·        Discounts on cell phone plans, rental cars, gyms, hotels and more

·        See a comprehensive list of benefits here. 

DETAILED JOB DESCRIPTION

·        Research payer denials related to referral, authorization, notifications, and medical necessity resulting in denials and delays in payment.

·        Submit retro-authorizations in accordance with payer requirements in response to authorization denials.

·        Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up and/or root-cause avoidance and resolution.

·        Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.

·        Review payer communications, identifying risk for loss reimbursement related to medical policies and authorization requirements; escalate potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate.

·        Identify opportunities for process improvement and actively participate in process improvement initiatives.

·        May complete unit/department specific duties as outlined in department documents.

KNOWLEDGE, SKILLS, AND ABILITIES

·        Ability to evaluate and investigate issues to determine effective resolution to avoid negative financial impact.

·        Excellent interpersonal, written, and verbal skills.

·        Ability to communicate effectively with a variety of individuals including physicians and clinical team members.

·        Proficient in Microsoft Office (including Excel and PowerPoint) and in personal computer use.

REQUIRED QUALIFICATIONS

·        Missouri Board of Nursing LPN or Nurse Licensure Compact multi-state LPN. When primary state of residency changes, compact state LPNs must apply under new state of residency within thirty (30) days.

·        Two (2) years of relevant experience in utilization review, denials management, prior-authorization, medical auditing, or similar healthcare experience.

PREFERRED QUALIFICATIONS

·        Experience with medical and insurance terminology, CPT, ICD-10 coding structures, and billing forms.

·        Experience with payer guidelines and CMS Utilization Management and billing requirements.

·        Experience with working with data to analyze, trend, and present findings.

·        Additional license/certification requirements as determined by the hiring department.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

The University of Missouri is an Equal Opportunity Employer.