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

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