Clinical Appeals Specialist (Patient Accounting)- Remote

Asante; Medford (OR); Remote; USD 60,000 - 90,000; Full time

Job summary

An innovative healthcare provider is seeking a Clinical Appeals Specialist to oversee clinical denials and enhance the appeal process. This remote position requires a Registered Nurse with substantial experience in denial management and reimbursement methodologies. You will be responsible for analyzing clinical documentation, crafting responses, and collaborating with leadership to improve efficiency and mitigate revenue loss. Join a team that values excellence, respect, and teamwork, and enjoy a competitive salary, comprehensive health benefits, and a supportive work-life balance. This is an exciting opportunity to make a significant impact in patient care and operational efficiency.

Benefits

Health plans including medical, dental, and vision

Retirement package with employer contribution

Generous earned time off (ETO)

Tuition reimbursement and repayment plans

Qualifications

• Minimum 3 years of Clinical RN experience with Denial Management or Case Management.
• Current RN license in Oregon or approved state for remote work required.

Responsibilities

• Manage clinical denials through comprehensive review and timely responses.
• Communicate denial trends to management and lead performance improvement initiatives.

Skills

Clinical RN experience

Denial Management

Case Management

Reimbursement methodologies

Preparing appeals for clinical denials

Education

Bachelor's degree in Nursing

Certified Clinical Documentation Integrity Specialist (CCDS)

Certified Case Manager (CCM)

Job description

Clinical Appeals Specialist (Patient Accounting)- Remote

Additional Position Details: FTE: 1.000000 | Full Time | Primarily Mon - Fri / 8AM - 5PM

Please Note: This is a remote position. Candidates will be required to have reliable broadband internet and personal cell phone service. Remote work may include online training and working day-to-day operations during Pacific Standard business hours.

Position Summary

The Clinical Appeals Specialist is responsible for managing clinical denials by conducting a comprehensive review of clinical documentation and formulating a timely and defensible written response based on clinical documentation, evidence based medical necessity criteria, physician documentation and medical policies of the payor. Communicates identified denial trends and patterns to the Manager of Patient Accounting, the Director of Revenue Cycle and all applicable patient accounting leaders. Works to review, evaluate and improve the enterprise clinical denial and appeal process. At the direction of the Manager of Patient Accounting, this individual will orchestrate education and other performance improvement initiatives to impact clinical quality, improve efficiency and mitigate lost revenue related to medical necessity denials.

Qualifications

• Minimum 3 years of Clinical RN experience, including 1 year of Denial Management OR Case Management OR related experience AND 1 year of current experience with reimbursement methodologies, required
• RN: Registered Nurse licensed by the Oregon State Board of Nursing, OR RN (Registered Nurse) with an active license in a state approved for remote work in this position, required
• Bachelor's degree in Nursing or allied health field or equivalent,preferred
• Experience preparing appeals for clinical denials,preferred
• CCDS: Certified Clinical Documentation Integrity Specialist by ACDIS,preferred
• CCM: Certified Case Manager,preferred

Total Rewards Package

• Earn a competitive and progressive salary.
• Benefit from health plans that focus on health and wellness including medical, dental, vision and wellness beginning within 30 days of hire.
• Plan for your future with a retirement package that includes up to 6% employer contribution.
• Experience a healthy work-life balance with our generous earned time off (ETO).
• Continue to enhance your education through our tuition reimbursement and tuition repayment plans.

Explore Asante more by visiting www.asante.org/careers

At Asante we believe that we are defined by our values - the traits that guide us as we serve patients and the community:

Excellence - Respect - Honesty - Service - Teamwork

Asante is an equal opportunity employer. We are committed to employ and advance in employment women, minorities, qualified individuals with disabilities and protected veterans.