Denial Mitigation-Specialist I

Baptist Memorial Health Care Corporation; Memphis (TN); On-site; USD 55,000 - 75,000; Full time

Job summary

Baptist Memorial Health Care Corporation is hiring a Denial Mitigation Specialist to review clinical information and supporting documentation for outpatient or Part B services, determining appeal actions. Reports to the department manager and contributes to reimbursement optimization.

The role requires strong communication, organization, and critical thinking; experience with EMR and payer processes is preferred.

Qualifications

• 3 years clinical experience and 3 years payer experience.
• Ability to type accurately and have strong organizational skills.
• Experience in outpatient or inpatient clinical setting.
• Familiarity with electronic medical records and claims/practice management systems.
• Excellent communication skills.

Responsibilities

• Reviews, assesses, and evaluates all communications to optimize reimbursement.
• Evaluates clinical information prior to initial appeal action to optimize reimbursement and utilization of resources.
• Prepares responses to appeals or information requests based on supporting clinical information.
• Compiles, analyzes, and distributes necessary clinical and financial information and presents reports to other healthcare providers to improve performance and resource usage.
• Completes assigned goals.

Skills

Excellent communication skills

Strong organizational skills

Critical thinking

Decision making

Tools

EMR systems

Claims/PM systems

Job description

Overview

Job Summary

Reviews clinical information and supporting documentation for outpatient or Part B services to determine appeal action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned.

Job Responsibilities

• Reviews, assesses, and evaluates all communications received in order to optimize reimbursement.
• Evaluates clinical information and supportive documentation prior to initial appeal action in order to optimize reimbursement and utilization of resources.
• Prepares response to appeal/request for information based on supporting clinical information in order to enhance reimbursement and maximize customer satisfaction.
• Compiles, analyzes, and distributes necessary clinical and financial information and presents reports to other healthcare providers in order to improve performances, and increase awareness of resources consumed related to reimbursement.
• Completes assigned goals.

Minimum Required Experience

3 years clinical experience and at least or 3 years payer experience.

Minimum Required Education

Ability to type and/or key accurately and have strong organizational skills.

Minimum Required Training

Requires critical thinking and judgement and must demonstrates the ability to appropriately use standard criteria established by payers.

Experienced in working in an outpatient or inpatient clinical setting.

Familiarity with electronic medical records and claims/practice management systems.

Minimum Required Special Skills

Excellent communication skills.

Advanced computer literacy skills with the ability to type and key accurately.

Preferred/Desired Licensure

RN, LPN or RHIT preferred not required