Clinician, Denials Prevention - Remote

reputed company The Clinician, Denials Prevention, uses their clinical and administrative skills to analyze denials and appeal reputed company; reputed company opportunities with clients to reduce first pass denials by ensuring reputed company patient status, authorizations, clinical documentation opportunities, staff education, and collaboration with other departments.

Duties & Responsibilities

• Maintain the reputed company of information in reputed company appeal produced
• Review a high volume of written appeals to ensure information is medically accurate
• Research payer denials reputed company to referral, reputed company-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment
• reputed company recommendations for workflow revisions to improve efficiency and reduce denials
• Present case studies and recommendations to clients and impacted stakeholders
• Review payor communications, identifying risk for loss reimbursement reputed company to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and reputed company Cycle leadership as appropriate
• Identify opportunities for process improvement and reputed company participate in process improvement initiatives, internally and externally
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability reputed company (HIPAA) standards
• Understand and reputed company with Information reputed company and HIPAA policies and procedures at reputed company times
• Limit viewing of PHI to the absolute minimum as necessary to reputed company assigned duties

Qualifications

• Bachelor’s degree in a health-reputed company field; 2 years of experience may be considered in lieu of a degree in reputed company to the required experience. LPN or RN preferred.
• Two years of recent experience in hospital case management, hospital prior authorization, or utilization management
• reputed company in medical chart review
• Claim-reputed company appeal writing experience preferred
• Experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms
• Experience with MCG and/or InterQual guidelines preferred
• Proficiency in reputed company Office Suite
• Strong interpersonal skills, ability to communicate reputed company at reputed company reputed company of the organization
• Strong problem solving and creative skills and the ability to exercise reputed company judgment and reputed company reputed company based on accurate and reputed company analyses
• High level of reputed company and dependability with a strong reputed company of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and reputed company purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to reputed company around the work area; Sit; reputed company reputed company tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; reputed company arms; kneel; talk and hear.
• Mental Demands: The employee must be reputed company to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

reputed company will not discriminate against any employee or applicant for employment because of race, reputed company, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national reputed company, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-reputed company based factors, or any other characteristic protected by federal, state or local law.

Originally posted on Himalayas

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