Clinician, Denials Management - Remote

Med-Metrix • Garden City, NY

5d • Remote

About The Position

The Clinician, Denials Management will review appeals against medical records to ensure accuracy and thoroughness.

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

What This Job Offers

• Job Type: Full-time