Remote Medicare & Regulatory Clinical Appeals Specialist

Priority Management; Dallas (TX); À distance; USD 55 000 - 85 000; Plein temps

Résumé du poste

Priority Management is seeking a Clinical Appeals Specialist to perform comprehensive clinical reviews and prepare supporting medical records for Medicare/Medicaid audits and appeals. The role requires proficiency in MDS coding, HIPAA compliance, and regulatory documentation within a post-acute care setting.

You will develop clinical appeal arguments, synthesize information from EHRs, and coordinate with teams in a remote, production-oriented environment to meet strict deadlines.

Qualifications

• Experience with documentation requirements for skilled rehabilitation and skilled nursing services.
• MDS coding and/or medical necessity reviews and appeals in skilled nursing or post-acute care settings.
• Working knowledge of regulatory and payer reimbursement requirements and reasons for claim denials.

Responsabilités

• Conduct clinical reviews of records to determine required supporting documentation.
• Develop appeal arguments using clinical evidence and regulations; provide testimony as needed.
• Ensure HIPAA compliance and report suspected violations; maintain data accuracy and security.

Connaissances

HIPAA compliance

MDS coding

Medicare/Medicaid regulations

Data analysis

Communication

Time management

Independent work

Attention to detail

Problem solving

Regulatory documentation

Formation

BA/BS in healthcare administration or related field

Case management certification (preferred)

Outils

PointClickCare

Microsoft 365

EHR systems

PDF editing

Description du poste

Priority Management is seeking a Clinical Appeals Specialist to perform comprehensive clinical reviews and prepare supporting medical records for Medicare/Medicaid audits and appeals. The role requires proficiency in MDS coding, HIPAA compliance, and regulatory documentation within a post-acute care setting.

You will develop clinical appeal arguments, synthesize information from EHRs, and coordinate with teams in a remote, production-oriented environment to meet strict deadlines.