Clinical Appeals & Denials Specialist

Gibson Area Hospital & Health Services; Gibson City (IL); On-site; USD 52,000 - 76,000; Full time

Job summary

Gibson Area Hospital & Health Services seeks a Patient Financial Services Appeals Specialist to review patient records and clinical documentation to determine medical necessity and support denials. You will prepare thorough appeal letters and submit documentation to maximize reimbursement while complying with payer regulations and policies.

Collaborate with physicians, nurses, and other clinical staff to gather documentation, track appeals, and communicate findings.

Qualifications

• Strong knowledge of medical terminology and clinical procedures.
• Experience with medical billing and coding in a hospital setting.
• Understanding of payer guidelines and coverage requirements.
• Ability to analyze clinical information and prepare evidence-based appeals.

Responsibilities

• Review patient records and documentation to determine medical necessity and support appeals.
• Identify denial bases and research payer policies and guidelines.
• Prepare clear, thorough appeal letters with supporting documentation.
• Submit appeals within payer deadlines and track outcomes.
• Collaborate with physicians and clinical staff to obtain additional documentation.

Skills

Medical terminology

Medical billing

Medical coding

Clinical documentation

Payer guidelines

Communication

Detail-oriented

HIPAA compliance

Job description

Gibson Area Hospital & Health Services seeks a Patient Financial Services Appeals Specialist to review patient records and clinical documentation to determine medical necessity and support denials. You will prepare thorough appeal letters and submit documentation to maximize reimbursement while complying with payer regulations and policies.

Collaborate with physicians, nurses, and other clinical staff to gather documentation, track appeals, and communicate findings.