Specialist-Denial I

Baptist; Memphis (TN); On-site; USD 58,000 - 75,000; Full time

Job summary

A healthcare organization in Memphis, TN is seeking a professional to optimize reimbursement through thorough evaluation of clinical information and documentation for outpatient services. Candidates should possess a minimum of 3 years of clinical and payer experience. Excellent communication and advanced computer literacy skills are essential. This role involves preparing responses to appeals and compiling necessary reports to improve resource awareness and performances.

Qualifications

• 3 years clinical experience required.
• 3 years payer experience required.
• Familiarity with electronic medical records.

Responsibilities

• Review and assess communications to optimize reimbursement.
• Evaluate clinical information prior to appeal action.
• Prepare responses to appeals based on clinical information.
• Compile and analyze necessary clinical and financial information.
• Complete assigned goals.

Skills

Clinical experience

Payer experience

Excellent communication skills

Advanced computer literacy

Organizational skills

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.

Experience

Minimum Required

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

Education

Minimum Required

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

Training

Minimum Required

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.

Special Skills

Minimum Required

Excellent communication skills.

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

Licensure

Preferred/Desired

RN, LPN or RHIT preferred not required