Clinical Appeals Liaison

Lifepoint Health • Franklin, TN

21h • Remote

About The Position

As a Clinical Appeals Liaison, you will leverage your clinical expertise to review and analyze insurance denials in order to initiate appeal letters. You will understand federal requirements for inpatient rehabilitation facilities. You’ll be responsible for reviewing denied insurance claims for medical treatment, thoroughly analyzing patient medical records to determine if the denial was justified. The Clinical Appeals Liaison will prepare comprehensive appeals packages, including detailed clinical narratives and necessary supporting medical records, for presentation to insurance companies to substantiate and advocate for patient access to necessary care, utilizing your clinical expertise to support the medical necessity of requested services.

Requirements

• Must be licensed as a RN, PT, or OT
• Minimum of 2 years of Inpatient Rehabilitation Hospital experience
• Minimum 3 years of clinical experience
• Excellent oral and written communication and interpersonal skills.

Responsibilities

• Review and analyze insurance denials to initiate appeal letters.
• Understand federal requirements for inpatient rehabilitation facilities.
• Review denied insurance claims for medical treatment.
• Analyze patient medical records to determine if the denial was justified.
• Prepare comprehensive appeals packages, including detailed clinical narratives and necessary supporting medical records.
• Present appeals packages to insurance companies to substantiate and advocate for patient access to necessary care.
• Utilize clinical expertise to support the medical necessity of requested services.

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Ongoing learning and career advancement opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed