Clinical Denials Specialist

Firstsource

Louisville, KYFull-time$7.25/hrSeen todaySeen in employer's feed today

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At a glance

Compensation

$7.25/hr

Location

Louisville, KY

Schedule

Full-time

Work Authorization

Not specified

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Requirements

Credentials this posting asks for.

Associate's degree

Job overview

The Clinical Denial Specialist manages clinically related claim denials, reviews claims, and recommends resubmission, retro authorization, written appeals, or no action. The specialist prepares and submits appeals based on clinical documentation, payer medical policies, and contract language, then tracks outcomes and trends. The role also reviews payer coverage guidelines, identifies process improvements, and reports findings to management.

Skills & qualifications

RequiredNice to have

Skills

Denial ManagementAppeal WritingUtilization ReviewInsurance Payer KnowledgeElectronic Health RecordsEpicCernerMeditechPC ProficiencyTypingWritten CommunicationVerbal CommunicationPrioritizationOrganizationTime ManagementProfessionalismIndependent Work

Qualifications

Associate's DegreeBusiness or Healthcare FieldRegistered Nurse CertificationCare Management ExperienceUtilization Review ExperiencePrior Authorization ExperienceAppeals ExperienceType 30-40 Wpm

Benefits

Medical Insurance

Vision Insurance

Dental Insurance

401(k) Match

Paid Time Off

Full job description

Experience Required

None

Minimum Education Required

Associates Degree

Compensation

$7.25 / hourly

Hours Per Week

Number Of Positions

Work Schedule and Shift Requirements

First (Day)

Job Description

Role: Clinical Denial Specialist

Schedule:M - F 8 AM - 4:30 PM EST

GENERAL SUMMARY:

The goal of theClinical Denial Specialist is to successfullymanage claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, and other clinically related denials, as assigned. The specialist will review claims and make recommendations for claim resubmission, retro authorization, written appeal or if no action is needed.

The Clinical Denial Specialist will write / submit professionally written appeals including arguments based on the clinical documentation, payer medical policies and contract language. The appeals will be submitted timely and tracked for outcome and trends.

Foundation Knowledge, Skills, and/or Abilities Required:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Essential Duties and Responsibilities:

Research assigned payer denials (referral, authorization, notification, medical necessity and non-covered services)

Independently write / submit professional appeal letters in accordance with client and payer policies

Prepares reports for management review and identifies trends.

Reviews and understands utilization review and coverage guidelines for multiple payers

Identify process improvement opportunities

Monitor denial and appeal outcomes and trends, and report findings to management.

Ensure all denial management activities comply with federal, state and payer regulations, including HIPAA rerquirements.

Additional Duties and Responsibilities:

Meet specified goals and objectives as assigned by management on a regular basis.

Maintain confidentiality of account information at all times.

Maintain awareness of and actively participate in the Corporate Compliance Program.

Assist with other projects as assigned by management

Maintain good working relationships with state and Federal agencies.

Resolve accounts in a timely manner.

Maintain a neat and orderlywork station

Educational/Vocational/Previous Experience Recommendations:

Associates Degreein a business or healthcare related field.

Registered Nurse (RN) Certification with experience in care management, utilization review,prior authorizationand appeals.

Electronic Health Record Experience with various platforms (Epic, Cerner, Meditech)

Knowledge of all insurance payers preferred.

Proficient PC knowledge and the ability to type 30-40 wpm.

Professional written and verbal communication skills.

Capacity to prioritize multiple tasks in a busy work environment.

Organization and time management skills.

Capability to present oneself in a courteous and professional manner at all times.

Ability to stay on task with little or no supervision.

Working Conditions:

Must be able to sit for extended periods of time.

Benefits including but not limited to: Medical, Vision, Dental, 401K, Paid Time Off.

We are an Equal Opportunity Employer. All qualified applicants are considered for employment without regard to r ace, color, age, r eligion, s ex, s exual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.

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