- Maintain the integrity of information in each appeal produced by the Firm
- Review a high volume of written appeals to ensure information is medically accurate
- Use, protect and disclose patients’ protected health information (PHI) only in accordance with the Health Insurance Portability and Accountability Act (HIPAA) standards.
- Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
- Make recommendations for workflow revisions to improve efficiency and reduce denials.
- Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate.
- Identify opportunities for process improvement and actively participate in process improvement initiatives.
- 4-year degree required
- Must be a Registered Nurse with clinical experience
- Experienced in medical chart review
- Hospital nursing experience
- Strong written communication skills
- Basic knowledge of MS Excel and the ability to learn proprietary databases
- Ability to meet on-going deadlines
- Exceptionally detail-oriented
- Must work cooperatively and efficiently under pressure
- Must be goal-oriented
- Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
- Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
- Work Environment: The noise level in the work environment is usually minimal.
Clinician, Denials Management – Remote
Med-Metrix
Appeals | Denials, Entry Level, Registered Nurse | RN
Remote
Employment Type:
Regular | Perm Employee
Schedule:
Full-time
Remote Status:
Remote
License:
Any State | US
Med-Metrix
Appeals | Denials, Entry Level, Registered Nurse | RN
Remote
Employment Type:
Regular | Perm Employee
Schedule:
Full-time
Remote Status:
Remote
License:
Any State | US