Clinical Denials Audit Analyst RN, Full Time

Unity Health • Searcy, AR

17d

About The Position

The Clinical Denial Audit/Analyst RN performs advanced level work related to clinical denial management. The individual is responsible for managing claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, etc.  Will assist with the tracking notification and following of denials in Compliance 360. The Clinical Denial Audit/Analyst RN writes and submits professional appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language and coding guidelines. Appeals are submitted timely and tracked through until final outcome. Will also handle audit-related / compliance responsibilities and other administrative duties as required. Works independently to plan, schedule, and organize activities that directly impact hospital and physician reimbursement and assist in creating and maintaining documentation of key processes.

Requirements

• Minimum of an associate’s degree in nursing is required; BSN is preferred.
• Requires a current RN license for the state of Arkansas.
• Must have two (2) years of relevant experience.
• Minimum of two (2) years’ recent experience in hospital case management and/or hospital revenue cycle required.
• Should have experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms.
• Should have knowledge of Medicare, Medicaid and third-party reimbursement methodologies and of local, state and federal healthcare regulations.
• Must have the ability to make good decisions in demanding situations, focus on continuous process improvement, have effective communication skills, and the ability to listen empathically.
• Should possess extensive writing capabilities and the ability to organize details logically and accurately.
• Must have the ability to manage multiple tasks easily and efficiently, work independently, and be results oriented.
• Must have the ability to multitask and use various computer applications.
• Basic math skills and knowledge of general accounting principles are necessary.

Nice To Haves

• Three (3) years of experience in a healthcare revenue cycle or clinic operations role with one (1) of those years being in a role which included claim-related appeal writing is preferred.

Responsibilities

• managing claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, etc.
• assisting with the tracking notification and following of denials in Compliance 360
• writing and submitting professional appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language and coding guidelines
• handling audit-related / compliance responsibilities
• performing other administrative duties as required
• planning, scheduling, and organizing activities that directly impact hospital and physician reimbursement
• assisting in creating and maintaining documentation of key processes

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree