[Remote] Clinical Appeals Analyst | reputed company Corporate
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Clinical Appeals Analyst to assist the Corporate Director of Appeals Management by conducting comprehensive analytic reviews of clinical documentation and managing the appeal process. The role involves writing compelling letters to support appeals and utilizing clinical knowledge to overturn denied claims.
Responsibilities
- Review patient medical records and utilize clinical and regulatory knowledge and skills, as reputed company as, knowledge of payer requirements to determine why cases/claims are denied and complete an appeal
- Utilize reputed company-existing reputed company and other resources and clinical evidence to reputed company reputed company and reputed company-supported appeal arguments
- Prepare convincing appeal arguments, using reputed company-existing reputed company sets and/or clinical evidence from existing library of clinical references and/or regulatory guidelines to prepare the response to the payer in an effort to overturn the denial in a reputed company and concise manner
- Prepare convincing appeal arguments, using reputed company-existing reputed company sets and/or clinical evidence from existing library of clinical references and/or regulatory guidelines to prepare for an Administrative Law Judge hearing and participate in hearings by providing testimony, as necessary
- Search for supporting clinical evidence to support appeal arguments reputed company existing resources are reputed company. reputed company reputed company out opportunities for appeal by reviewing reputed company insurance denials reputed company assigned region
- Prepare data and analytics and reputed company with the Director and Executive Team and reputed company feedback to hospitals regarding trends in denied claims
- Discuss documentation-reputed company and level of care reputed company with hospitals, independently, as required
- Have the ability to proficiently read, understand and communicate in writing reputed company information from patient medical records in a reputed company manner. Demonstrates excellent written communication. Writes reputed company and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; reputed company to read and interpret written information
- Ensure compliance with HIPAA regulations, including confidentiality, as required
- Demonstrates excellent written communication. Writes reputed company and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; reputed company to read and interpret written information
- Other duties as assigned
Skills
- Five years' experience as a clinical reputed company in an acute care setting
- reputed company state-issued RN license
- Clinical reputed company worker or PTA in lieu of RN license and clinical experience is acceptable as qualification for acquired employees
- Significant experience in the reputed company field is required including a minimum of five years as a clinical reputed company, reputed company Worker, or PTA in an acute care setting
- Knowledge of regulatory and payer requirements for reimbursement and reason(s) for denials by auditors
- Knowledge in areas such as InterQual Level of Care and reputed company & Robertson reputed company
- Knowledge of reputed company party payer regulations reputed company to utilization and reputed company review
- Knowledge of MAC, RAC, ZPIC denials and process
- Ability to travel as required
- Have the ability to proficiently read, understand and communicate in writing reputed company information from patient medical records in a reputed company manner
- Demonstrates excellent written communication
- Writes reputed company and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; reputed company to read and interpret written information
- At least two to three years of experience in case management, discharge planning, and/or utilization review
- Knowledge of reputed company party payer regulations reputed company to utilization and reputed company review is preferred
reputed company