Clinical Operations Appeals Specialist
New
A
Advanced Oxygen Therapy, Inc.Wound care
RemoteFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of 3 years of progressive experience in healthcare reimbursement, utilization management, appeals, prior authorization, case management, or clinical documentation review; Minimum of 2 years of wound care or advanced wound therapy experience.
- Required Skills
- Project Management
Requirements
- Licensed healthcare professional preferred (RN, BSN, LPN/LVN, PT/PTA, OT/COTA, MSW, or comparable clinical background).
- Minimum 3 years of experience in healthcare reimbursement, utilization management, appeals, prior authorization, case management, or clinical documentation review.
- Minimum 2 years of wound care or advanced wound therapy experience.
- Demonstrated expertise in interpreting payer policies and applying clinical judgment.
- Ability to independently manage complex projects and competing priorities.
- Strong analytical, organizational, and problem-solving skills.
- Exceptional written communication skills with the ability to develop persuasive medical documentation.
- Competency in medical necessity interpretation and appeals strategy development.
Responsibilities
- Serve as the national subject matter expert for insurance denials and appeals across all payer types.
- Independently assess complex denials and determine evidence-based appeal strategies.
- Develop persuasive appeal packages including Letters of Medical Necessity and clinical summaries.
- Collaborate with physicians and clinical staff to obtain and improve documentation quality.
- Analyze payer trends to decrease denial rates and improve reimbursement outcomes.
- Provide education and strategic consultation to field sales and regional leadership teams.
- Lead continuous improvement initiatives for appeal success and workflow efficiency.
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