Clinician, Denial Management - Remote

Med Metrix•Garden City, NY

17h•Remote

About The Position

The Clinician, Denials Management will review appeals against medical records to ensure accuracy and thoroughness. Duties & Responsibilities Maintain the integrity of information in each appeal produced Review a high volume of written appeals to ensure information is medically accurate 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 Other duties as assigned Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Understand and comply with Information Security and HIPAA policies and procedures at all times Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Requirements

4-year degree in a related field is required
Must be a Registered Nurse with clinical experience
Experience in medical chart review
Hospital nursing experience
Ability to learn proprietary databases
Proficiency in Microsoft Office Suite
Strong interpersonal skills, ability to communicate well at all levels of the organization
Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
High level of integrity and dependability with a strong sense of urgency and results oriented
Excellent written and verbal communication skills required
Gracious and welcoming personality for customer service interaction
Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.

Responsibilities

Maintain the integrity of information in each appeal produced
Review a high volume of written appeals to ensure information is medically accurate
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
Other duties as assigned
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Understand and comply with Information Security and HIPAA policies and procedures at all times
Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties