Clinical Government Audit Analyst & Appeal Specialist II (Remote)

Stanford Health Care; Myrtle Point (OR); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare organization in Myrtle Point, Oregon is seeking a professional to handle denials and appeals. The role includes conducting thorough analyses, developing appeal strategies, and collaborating with clinical teams. Candidates should have a Bachelor's degree and at least two years of relevant experience. Strong communication skills and proficiency in systems like EPIC are essential. This position offers competitive compensation and opportunities for growth.

Benefits

Opportunity for career advancement

Collaborative environment

Commitment to diversity and equal opportunity

Qualifications

• Bachelor’s degree from an accredited college or university.
• Minimum two years of progressive denials and appeals experience.
• Knowledge of coding structures and billing forms.

Responsibilities

• Conduct analyses of denials and identify overpayments.
• Compose professional appeal letters ensuring compliance.
• Collaborate with teams to gather information for appeals.

Skills

Strong communication skills

Knowledge of medical and insurance terminology

Proficiency in computer systems

Education

Bachelor’s degree in a relevant field

Tools

EPIC

3M

Microsoft Office Suite

Job description

Overview

Employer Industry: Healthcare Services

Compensation and Benefits

• Salary up to $83.16 per hour
• Opportunity for career advancement and growth within the organization
• Engage in meaningful work that contributes to the financial health of the organization
• Collaborative environment working with clinical staff and coding professionals
• Involvement in developing appeal strategies and audit tools
• Commitment to diversity and equal opportunity in the workplace

What to Expect (Job Responsibilities)

• Conduct thorough analyses of denials, ensuring accurate coding and identifying overpayments and underpayments
• Independently compose professional appeal letters to payors, ensuring compliance with relevant guidelines
• Develop comprehensive appeal strategies and provide thoughtful appealability scores for each denial
• Collaborate with clinical teams to gather necessary information to support appeals
• Stay updated on healthcare regulations and participate in developing policies and procedures for the Denials Management Department

What is Required (Qualifications)

• Bachelor’s degree in a work-related discipline/field from an accredited college or university
• Minimum two (2) years of progressive denials and appeals experience
• Strong communication skills, both written and verbal
• Knowledge of medical and insurance terminology, coding structures, and billing forms
• Proficiency in computer systems, specifically EPIC and 3M, as well as Microsoft Office Suite

How to Stand Out (Preferred Qualifications)

• Experience with coding, clinical validation, and medical necessity for inpatient stays
• Certification in coding (CCA, CCS, COC, CDIP, or CCDS) or RN state licensure within 180 days
• Ability to apply critical thinking skills to identify patterns and trends
• Demonstrated flexibility in responding to new challenges and evolving healthcare regulations
• Extensive writing capabilities and efficiencies