Clinician, Denials Management - Remote

• Maintain the integrity of information in each appeal produced by the Firm
  • Review a high volume of written appeals to ensure information is medically accurate
  • Use, protect and disclose patients’ protected health information (PHI) only in accordance with the Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
  • Make recommendations for workflow revisions to improve efficiency and reduce denials.
  • Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates 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.
  
  • 4-year degree required
  • Must be a Registered Nurse with clinical experience
  • Experienced in medical chart review
  • Hospital nursing experience
  • Strong written communication skills
  • Basic knowledge of MS Excel and the ability to learn proprietary databases
  • Ability to meet on-going deadlines
  • Exceptionally detail-oriented
  • Must work cooperatively and efficiently under pressure
  • Must be goal-oriented
  
  
  • Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
  • Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
  • Work Environment: The noise level in the work environment is usually minimal.

Originally posted on Himalayas