Denial Mitigation Specialist I: Reimbursement Optimizer

Baptist Memorial Health Care; Memphis (TN); On-site; USD 60,000 - 80,000; Full time

Job summary

Baptist Memorial Health Care in Memphis, TN seeks a denial mitigation professional to review clinical information and documentation for outpatient or Part B services and determine appeal actions. You will report to the manager of the Denial Mitigation Department and support continued process improvements.

The role focuses on optimizing reimbursement, evaluating clinical data, and preparing appeals with supporting information.

Qualifications

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

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.

Skills

Excellent communication skills

Typing / data entry

Organizational skills

EMR familiarity

Tools

EMR systems

Practice management software

Job description

Baptist Memorial Health Care in Memphis, TN seeks a denial mitigation professional to review clinical information and documentation for outpatient or Part B services and determine appeal actions. You will report to the manager of the Denial Mitigation Department and support continued process improvements.

The role focuses on optimizing reimbursement, evaluating clinical data, and preparing appeals with supporting information.