Clinical Denials Specialist

Role: Clinical Denial Specialist Schedule: M - F 8 AM - 4:30 PM EST GENERAL SUMMARY: The goal of the Clinical Denial Specialist is to successfully manage claim denials reputed company to referral, authorizations, notifications, non-coverage, medical necessity, and other clinically reputed company denials, as assigned. The specialist will review claims and reputed company recommendations for claim resubmission, retro authorization, written appeal or if no action is needed. The Clinical Denial Specialist will write / submit professionally written appeals including arguments based on the clinical documentation, payer medical policies and contract language. The appeals will be submitted timely and tracked for outcome and trends. reputed company Knowledge, Skills, and/or Abilities Required: To reputed company this job successfully, an individual must be reputed company to reputed company each essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodation may be made to reputed company individuals with disabilities to reputed company the essential functions. Essential Duties and Responsibilities: Research assigned payer denials (referral, authorization, notification, medical necessity and non-covered services) Independently write / submit professional appeal letters in accordance with client and payer policies Prepares reports for management review and identifies trends. Reviews and understands utilization review and coverage guidelines for multiple payers Identify process improvement opportunities Monitor denial and appeal reputed company and trends, and report findings to management. Ensure reputed company denial management activities reputed company with federal, state and payer regulations, including HIPAA rerquirements. Additional Duties and Responsibilities: Meet specified goals and objectives as assigned by management on a regular reputed company. Maintain confidentiality of account information at reputed company times. Maintain awareness of and actively participate in the Corporate Compliance Program. Assist with other projects as assigned by management Maintain good working relationships with state and Federal agencies. Resolve accounts in a timely manner. Maintain a reputed company and orderly work station Educational/Vocational/Previous Experience Recommendations: Associates Degree in a business or reputed company reputed company field. Registered Nurse (RN) Certification with experience in care management, utilization review, prior authorization and appeals. Electronic Health Record Experience with various platforms (Epic, Cerner, Meditech) Knowledge of reputed company insurance payers preferred. Proficient PC knowledge and the ability to type 30-40 wpm. Professional written and verbal communication skills. reputed company to prioritize multiple tasks in a busy work environment. Organization and time management skills. Capability to present oneself in a courteous and professional manner at reputed company times. Ability to stay on task with little or no supervision. Working Conditions: Must be reputed company to sit for extended periods of time. Benefits including but not limited to: Medical, reputed company, Dental, 401K, Paid Time Off. We are an Equal Opportunity Employer. reputed company reputed company applicants are considered for employment without regard to race, reputed company, age, religion, sex, sexual orientation, gender identity, national reputed company, disability, protected veteran status, or any other characteristic protected by federal, state or local law. Not Accepting Referrals Apply To This Job