Clinical Denial & Utilization Support Specialist

Carle-Health; Champaign (IL); On-site; USD 23,000 - 39,000; Full time

Job summary

Carle Health is seeking a Clinical Denial/Utilization Management Assistant in Champaign, IL. This role supports the Clinical Denial Management and Utilization Review teams by maintaining EPIC work queues and coordinating payer notifications and authorizations for patient stays.

The assistant ensures timely communication with payers and helps organize clinical appeal documentation. The position involves tracking life cycle data for clinical appeals, liaising with hospital and financial staff, and

Responsibilities

• Communicates effectively with Clinical Denial Management and Utilization Review teams to ensure denial letters are addressed in a timely manner.
• Reviews denials sent by payers and documents them into the Dragonfly software, EMR and/or tracking tool as appropriate to ensure appropriate tracking is maintained.
• Communicates with Clinical Denial Management and Utilization Review teams to help create strong processes and efficiencies.
• Submits all appeal documents to the payer accurately and timely.
• Organizes and maintains all clinical appeal documents, databases, and records in a systematic way.
• Reviews appealed cases in a systematic and timely fashion to ensure payment is received and notifies Clinical Denials Management team of new findings of review.
• Contacts insurance provider as directed when more information is needed.
• Gathers data for reporting purposes.
• Screens incoming calls, faxes or other digital communications related to clinical denials and directs it to the appropriate area.
• Perform projects, reviews and handles reports as assigned.
• Interacts with hospital, provider, and financial staff regarding determinations, appeals, and denials and gives direction as necessary.

Tools

Dragonfly software

EMR

Job description

Carle Health is seeking a Clinical Denial/Utilization Management Assistant in Champaign, IL. This role supports the Clinical Denial Management and Utilization Review teams by maintaining EPIC work queues and coordinating payer notifications and authorizations for patient stays.

The assistant ensures timely communication with payers and helps organize clinical appeal documentation. The position involves tracking life cycle data for clinical appeals, liaising with hospital and financial staff, and