Job Description
Under the general supervision of the Director of Revenue Cycle, the Clinical Denials and Appeals Specialist performs advanced level work related to Clinical Denial Management. The Clinical Denials and Appeals Specialist will be responsible for managing clinical denials by conducting a comprehensive review of clinical documentation and formulating a timely and defensible written response based on clinical documentation, evidence based medical necessity criteria, physician documentation and medical policies of the Payor. The Clinical Denials and Appeals Specialist will also communicate identified denial trends and patterns to the Director, UM Department, and HIM Department. This individual will work to review, evaluate and improve the organizations clinical denial and appeal process as well.
Minimum Education
Minimum Work Experience
Required Skills
Required Licenses
Eligible Benefits:
Screening Requirements:
Our Mission:
To improve the lives of those we serve by providing outstanding care and services through our confident, compassionate and exceptional healthcare professionals
Our Vision:
To be chosen by our community and expanded service region based on proven outcomes as the trusted provider to care for their families, friends and neighbors
Our Values:
Compassion, Competence, Excellence, Respect, Integrity
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