Clinical Denials Specialist
New
F
firstsourcHealthcare denial management
United States, M - F 8 AM - 4:30 PM ESTFull-Time
Salary not disclosed
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Job Details
- Required Skills
- EHRHIPAA
Requirements
- An associate degree in a business or healthcare-related field is recommended.
- RN certification with experience in care management, utilization review, prior authorization, and appeals is recommended.
- Electronic health record experience with platforms such as Epic, Cerner, or Meditech is recommended.
- Knowledge of insurance payers is preferred.
- Proficient PC knowledge and ability to type 30–40 words per minute.
- Professional written and verbal communication skills.
- Ability to prioritize multiple tasks in a busy work environment.
- Organization and time-management skills.
- Ability to work on task with little or no supervision.
- Ability to sit for extended periods.
Responsibilities
- Research assigned payer denials involving referrals, authorizations, notifications, medical necessity, and non-covered services.
- Review claims and recommend resubmission, retro authorization, written appeal, or no action.
- Write and submit professional appeal letters using clinical documentation, payer medical policies, and contract language.
- Track appeal submissions and outcomes in a timely manner.
- Prepare reports for management and identify denial and appeal trends.
- Review utilization review and coverage guidelines for multiple payers.
- Identify process improvement opportunities.
- Ensure denial management activities comply with federal, state, and payer regulations, including HIPAA requirements.
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