Clinical Appeal Specialist

Moffitt Cancer Center Partnership; Tampa (FL); Hybrid; USD 44,000 - 67,000; Full time

Job summary

Moffitt Cancer Center is hiring a Clinical Appeal Specialist to coordinate denials review and appeals in a remote-eligible role. You will manage reimbursement processes, analyze denials, and collaborate with payers to recover claims.

Qualified candidates have RN licensure, a relevant degree, and experience with Medicare/Medicaid policies. This full-time position offers on-site support while enabling virtual work options and a focus on oncology care.

Qualifications

• Associate's Degree in Healthcare, Finance, or related field.
• Bachelor's Degree plus five years healthcare experience with RN required (or Associate's plus seven years healthcare experience; RN preferred).
• RN license required.
• Accommodation: LPNs in the role may have time to obtain RN licensure.

Responsibilities

• Administer and coordinate denials review and appeals management processes.
• Conduct denials recovery and root cause analysis to identify improvements.
• Collaborate with care teams and payers to ensure compliant reimbursement.

Skills

Communication

Data analysis

Reimbursement knowledge

RN licensure understanding

Excel

Education

Associate's Degree

Bachelor's Degree

RN license

Tools

MS Office

MS Excel

MS Access

Soarian

Job description

Clinical Appeal Specialist - Moffitt Cancer Center### Clinical Appeal SpecialistApply: Virtual (Remote Eligible Position ): Magnolia Hospital: Full time: Posted Today: R-5073### Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer.### As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt employs some of the best and brightest minds from around the world. Join a dedicated team of nearly 11,000 who are shaping the future we envision. Moffitt has been recognized as a Best and Brightest Company to Work For in the Nation and is continually named one of the Tampa Bay Times’ Top Workplaces.**Summary**Responsible for the administration and coordination of the denials review and appeals management processes that includes denials management, claims recovery, and denial root cause analysis.**Minimum Required:**Associate's Degree in Healthcare, Finance, or other related field*\\* \"in lieu of\" Bachelor's please review Experience, minimum required below.* **Minimum Experience/Certification Required:*** Bachelors Degree plus a minimum of five (5) years healthcare experience and RN required (OR)* \"in lieu of\" a Bachelor's degree you must have an Associates degree plus a seven (7) years healthcare experience preferably in Nursing* RN license required. \\*\\*Accommodation: LPN's currently in the role of Clinical Denial Specialist will be given a specified time frame (2 years) to obtain the RN licensure **Additional Skills/ Specialized Training Required:**-Computer literate, knowledge of financial data analysis, Medicare and Medicaid regulations, third party reimbursement,and charging and coding guidelines. Intermediate Excel skills. Excellent communication skills both written and verbal JobRelated Skills:-Proficient in all aspects of reimbursement.-Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory andadministrative rules).-Knowledge of managed care industry including payer structures, administrative rules, and government payers-Adept in hospital and insurance reimbursement and billing concepts and procedures, as well as laws and regulationsaffecting payment compliance, denials and appeals recovery.-Proficiency with various reimbursement methodologies including, but not limited to, Per-Diem, DRG, fee schedule,percentage of charges, and stop loss.-Proficient understanding of medical coding systems effecting the adjudication of claims payment. These include ICD-9,CPT, HCPCS, DRG, APG, APC, and revenue code structures.-Proficiently utilizes MS Office applications, including MS Excel and MS AccessSoft Skills:-Ability to work collaboratively in a team environment or independently, as applicable.-Must be able to anticipate obstacles to a goal and initiates appropriate resolution.-Must have initiative to identify barriers and opportunities and provides solutions through process and operationalimprovements.-Requires investigation and analytical skills with a proven ability to communicate effectively in both written and verbalformat.-Able to communicate (both written and verbal) professionally and effectively.-Requires exceptional attention to detail and demonstrated ability to prioritize work to ensure accuracy and timelycompletion.**Preferred:**Experience in oncology nursing, utilization review, quality management, and/or recent case managementSoarian experience**Salary Range**$31.99 - $48.80*Salary ranges posted for this position represent the expected base pay range for the role. Actual compensation may vary based on location and a variety of job-related factors, including experience, skills, education, and internal equity among Team Members in similar positions.* *We are committed to maintaining fair and equitable pay practices and regularly review compensation to ensure alignment across our workforce.*