Summary

Sentara Health is a leading not-for-profit integrated healthcare delivery system serving Virginia, northeastern North Carolina, and Florida. Founded in 1888 and headquartered in Hampton Roads, Virginia, Sentara operates 12 acute care hospitals across its service area, with 10 hospitals holding prestigious Magnet® recognition for nursing excellence. The organization employs approximately 34,000 healthcare professionals and serves over 1 million health plan members through its Sentara Health Plans division. As one of the top 20 largest not-for-profit integrated health systems in the United States, Sentara is nationally recognized for clinical quality, safety, and innovation. The system has received numerous accolades including Health Quality Innovator of the Year (2024), Forbes' "America's Best-In-State Employer" (2024), and inclusion in IBM Watson Health's "Top 15 Health Systems." Sentara's comprehensive services span hospital care, outpatient facilities, home health, hospice services, and specialized programs like the Nightingale air ambulance service, which has completed over 20,000 missions since 1982.

Job description

Overview

Manage inpatient and outpatient provider appeals across all payer types, including government and commercial insurance
Review clinical denials (non-billing related), identify root causes, and perform post-claim analysis to support appeal submissions

Education

N-3YR - RN-Diploma (Non-degree) REQUIRED; Bachelors Degree in Nursing preferred

Certification/Licensure

Registered Nurse (RN) License (Compact or Virginia) preferred

Experience

3 years experience in Nursing REQUIRED
Experience/knowledge in Rev Cycle, Utilization Review (UR) and Case Management preferred
Provider appeals experience is a plus
Strong proficiency in Excel

Requirements

RN-Diploma (Non-degree) required
3 years experience in Nursing required
Bachelors Degree in Nursing preferred
Registered Nurse (RN) License (Compact or Virginia) preferred
Experience/knowledge in Rev Cycle, Utilization Review (UR) and Case Management preferred
Provider appeals experience is a plus
Strong proficiency in Excel

Benefits

Medical, Dental & Vision
Adoption, Fertility & Surrogacy Reimbursement
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term & Short-Term Disability
Life Insurance
401(k)/403(b) Matching
Tuition Assistance
Student Debt Pay Down
Pet Insurance
Legal Resources Plan
Annual Discretionary Bonus

Company overview

Sentara Health is a leading not-for-profit integrated healthcare delivery system serving Virginia, northeastern North Carolina, and Florida. Founded in 1888 and headquartered in Hampton Roads, Virginia, Sentara operates 12 acute care hospitals across its service area, with 10 hospitals holding prestigious Magnet® recognition for nursing excellence. The organization employs approximately 34,000 healthcare professionals and serves over 1 million health plan members through its Sentara Health Plans division. As one of the top 20 largest not-for-profit integrated health systems in the United States, Sentara is nationally recognized for clinical quality, safety, and innovation. The system has received numerous accolades including Health Quality Innovator of the Year (2024), Forbes' "America's Best-In-State Employer" (2024), and inclusion in IBM Watson Health's "Top 15 Health Systems." Sentara's comprehensive services span hospital care, outpatient facilities, home health, hospice services, and specialized programs like the Nightingale air ambulance service, which has completed over 20,000 missions since 1982.