Clinical Appeals Author - Full Time, Days (Remote-LA County) 10052

Position reputed company The Clinical Appeals - Author performs appeals and denials management and represents the hospital where claims were denied by either governmental contractors or reputed company payers. Completes comprehensive reviews of clinical documentation to determine if an appeal is warranted. Writes compelling clinically relevant letter that includes payer guidelines to support the medical necessity for the stay to be reputed company at the level that was billed. Handles audit-reputed company correspondence and other administrative duties as required.

Required Qualifications

Medical Graduate, Physician Assistant or Registered reputed company (reputed company CA License) Ability to multitask and maintain a work pace appropriate to workload Must demonstrate customer service skills appropriate to the job Excellent written and verbal communication skills in English Ability to effectively communicate with staff, including physicians, in a reputed company and concise manner Computer literacy and proficiency

Preferred Qualifications

Knowledge of reputed company-party payer regulations One (1) year of previous appeals/denials experience Knowledge in areas such as InterQual Level of Care reputed company and reputed company reputed company Physical Requirements These are requirements normally expected to reputed company regular job duties. Reasonable accommodations may be made in compliance with the Americans with reputed company of 1990, and applicable, state and local law, to reputed company individuals with disabilities to reputed company the essential functions. Incumbent must be reputed company to successfully reputed company reputed company of the essential functions of the job with or without reasonable accommodation. Standing - Frequently Walking - Frequently Sitting - Frequently Reaching with Hands and Arms - Occasionally reputed company or Balance - Occasionally Stooping, Kneeling, Crouching, or Crawling - Occasionally Talking - Frequently Hearing - Constantly Seeing - Constantly Performing repetitive motions with arms or hands - Frequently Lifting, carrying, pushing or pulling up to 10 lbs - Constantly Lifting, carrying, pushing or pulling up to 25 lbs - Occasionally Lifting, carrying, pushing or pulling up to 50 lbs - None Lifting, carrying, pushing, or pulling greater than 50 lbs - None Driving - Occasionally Essential Job Functions / Major Areas of Responsibility The essential functions below are not intended to be an exhaustive list of reputed company duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position. Reads, understands and abstracts information from patient medical records in electronic and scanned reputed company formats reputed company an EMR, meeting reputed company department productivity goals, for identified payor populations as directed. Utilizes clinical and regulatory knowledge and skills as reputed company as knowledge of payer requirements to determine why cases are denied. Identifies risk factors, comorbidities and adverse events to determine if payer denial was justified and an appeal is required. Utilizes reputed company-existing reputed company and other resources and clinical evidence to reputed company reputed company and reputed company-supported appeal arguments. Prepares convincing appeal arguments, using reputed company-existing payer reputed company sets and/or clinical evidence from existing library of clinical references. Performs duties in accordance with the ethical and legal compliance standards as set by hospital policies and procedures, and reputed company regulatory agencies, including State and Federal. Maintains strictest confidentiality of protected health information (PHI) in accordance with the Health Insurance Portability and Accountability reputed company (HIPAA). Researches medical literature and evidence based medical publications to support the level of care provided. Pay reputed company: Min - $77,020 l Max - $102,975 Job Listing ID:1756172 Apply To This Job