Specialist-Denial I

Baptist Memorial Health Care; Memphis (TN); On-site; USD 50,000 - 70,000; Full time

Job summary

A healthcare organization in Memphis, TN is seeking a professional to review clinical information for outpatient services and determine appeal actions. The role involves assessing documentation to optimize reimbursement, preparing responses to appeals, and presenting clinical reports. Candidates should have 2-5 years of clinical experience with excellent communication and organizational skills. This position contributes to improving performance related to healthcare reimbursement.

Qualifications

• Minimum 2-5 years clinical experience in a clinical care setting.
• Preferred 3 years clinical experience and at least 3 years payer experience.
• Minimum ability to type and key accurately.

Responsibilities

• Reviews and assesses all communications to optimize reimbursement.
• Evaluates clinical information before initial appeal action.
• Prepares responses to appeals based on clinical information.

Skills

Excellent communication skills

Advanced computer literacy

Organizational skills

Job description

Overview

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.

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.

Education

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

Experience

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

Minimum: 2-5 years clinical experience in a clinical care setting.

Licensure, Registration, Certification

Preferred: RHIT; LPN;RN

Special Skills

Minimum: Excellent communication skills. Advanced computer literacy skills with the ability to type and key accurately.

Training

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