Clinical Denial Specialist II
About The Position
The Clinical Denial Specialist II functions as a hospital liaison to appeal denied claims for Medicare, Medicaid, Managed and Commercial insurance. This position entails detailed retrospective review via EPIC of patient medical records to analyze and compile data for additional documentation request and claim denials, using trends and patterns identified to support process improvement. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Schedule: Monday – Friday, 8am - 5pm
Requirements
- Active Indiana RN license required
- BSN or Associate's with 5 years of nursing experience required
- 3 years of denial experience required
Nice To Haves
- 5 years of nursing or case management experience preferred
Responsibilities
- Develop reports
- Review governmental contractor’s response
- Identify underlying root causes for potential denials and works closely with departments and Clinical Documentation Integrity to reduce denials
- Write and ensure all appeals are filed in a prompt and timely manner for Medicare, Medicaid, Managed, and Commercials Payor
- Audit medical documentation for adherence to insurance and CMS guidelines relating to inpatient/observation services, or other denial issues
- Knowledge of inpatient criteria to establish medical necessity letters
Benefits
- Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
