Homeoffice Denials Management Specialist chez Pennant Services

We are building a world-class service Center and invite you to join a team of people who are committed to a core objective of supporting life-changing service and providing professional expertise to the operations and leaders we support.

About the Company

Pennant Services is one of the most dynamic and progressive companies in the rapidly expanding senior living, home health, hospice, and home care industries. Affiliates of Pennant Services now operate over 150 senior living, home health, hospice, and home care operations across 14 states, and we are growing! These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the “Service Center,” a world-class service team that provides the centralized clinical, legal, compliance, risk management, HR, training, accounting, IT and other resources necessary to allow on-site leaders and caregivers to focus squarely on day-to-day care and business issues in their individual agencies.

Something else that sets us apart from other companies is the quality of our most valuable resources – our people! We are dedicated to living out our culture as defined by our core values, “CAPLICO”:

Customer Second

Accountability

Passion for Learning

Love One Another

Intelligent Risk Taking

Celebrate

Ownership

By incorporating these principles at all levels of our organization, our employees feel valued and excited about their impact on our service center team members and operational partners. Our culture fosters personal and professional excellence and promotes development that leads to continued success.

JOB SUMMARY 

The Denials Management Specialist (DMS) Nurse’s primary objective is to collect, review, and submit documentation that supports claims requested for review by a government contractor. The DMS partners with Pennant’s Agencies, Revenue, Financial, and Legal Counsel to determine needs and work together to create and implement processes to improve outcomes.

DUTIES & RESPONSIBILITIES 

• Ensures CAPLICO Core Values and Code of Conduct are always adhered to. 

• Responsible for the record collection and review of Additional Documentation Requests (ADRs) from CMS to include UPICs, SMRCs, TPEs, and other external audits. 

• Review and analyze medical record documentation to complete appeals at all levels.  

• Understands and applies COPs (Medicare guidelines) and all other appropriate CMS or payer program guidelines regarding home health care and hospice. 

• Demonstrates problem-solving and critical thinking skills. 

• Manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, and organize and prioritize workload. 

• Highly flexible and motivated, able to work independently and in a team setting. 

• Provides recommendations related to audit findings to the agencies and clinical leaders. 

• Works within and is comfortable with HCHB, PDF-Xchange, Excel, and Smartsheet.  

• Ability to identify and communicate denial trends specific to reviews completed. 

• Able to collaborate with physicians and healthcare providers to clarify clinical documentation and obtain additional information when necessary.  

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description. 

JOB REQUIREMENTS (Education, Experience, Knowledge, Skills, & Abilities) 

• Registered Nurse or related licensure highly preferred.  

• Extensive experience and knowledge of Home Health and/or Hospice environment, typically gained by five or more years of industry-related experience.  

• Knowledge of Medicare and Medicaid regulations. 

• Flexible and responsive to changing assignments.  

• Detail and deadline-oriented with the ability to prioritize and multitask. 

• Able to adapt to a fast-paced environment and learn and retain new or evolving information and procedures. 

• Proficient in healthcare information systems and electronic medical records (EMR). 

Additional Information

We are committed to providing a competitive Total Rewards Package that meets our employees' needs.

We offer a comprehensive benefits package, from a choice of medical, dental, and vision plans to retirement savings opportunities through a 401(k), company match, and various other features. We believe in great work and celebrate our employees' efforts and accomplishments locally and companywide, recognizing people daily through our Moments of Truth Program. In addition to recognition,n we believe in supporting our employees' professional growth and development. We provide employees with a wide range of free e-courses through our Learning Management System, as well as training sessions and seminars.

Compensation: Based on experience.

Type: Full Time

Location: Remote

Pennant Service Center

1675 E. Riverside Drive, #150

Eagle, ID 83616

If you are interested in this position, please submit a resume for consideration. We look forward to hearing from you!

About The Pennant Group

We are proud to be affiliated with the Pennant Group, Inc. (NASDAQ: PNTG). Pennant was created in 2019 in connection with The Ensign Group, Inc.’s (NASDAQ: ENSG) spin-off of its home health, hospice, and senior living businesses. We believe that through our innovative operating model, we can foster a new level of patient care and professional competence at our independent operating subsidiaries and set a new industry standard for quality home health, hospice, and senior living services. You can learn more about The Pennant Group at www.pennantgroup.com