Specialist-Denial I

Baptist • Memphis, TN

2d

About The Position

Reviews clinical information and supporting documentation for outpatient or Part B services to determine appeal action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned.

Requirements

• Minimum Required 3 years clinical experience and at least or 3 years payer experience.
• Minimum Required Ability to type and/or key accurately and have strong organizational skills.
• Requires critical thinking and judgement and must demonstrates the ability to appropriately use standard criteria established by payers.
• Experienced in working in an outpatient or inpatient clinical setting.
• Familiarity with electronic medical records and claims/practice management systems.
• Minimum Required Excellent communication skills.
• Advanced computer literacy skills with the ability to type and key accurately.

Nice To Haves

• RN, LPN or RHIT preferred not required

Responsibilities

• Reviews, assesses, and evaluates all communications received in order to optimize reimbursement.
• Evaluates clinical information and supportive documentation prior to initial appeal action in order to optimize reimbursement and utilization of resources.
• Prepares response to appeal/request for information based on supporting clinical information in order to enhance reimbursement and maximize customer satisfaction.
• Compiles, analyzes, and distributes necessary clinical and financial information and presents reports to other healthcare providers in order to improve performances, and increase awareness of resources consumed related to reimbursement.
• Completes assigned goals.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees