Clinical Denials and Appeals Specialist

We are seeking a Clinical Denials and Appeals Specialist to join our team. The ideal candidate will have a strong background in clinical denials and appeals, with the ability to analyze complex medical records and identify areas for improvement. The Clinical Denials and Appeals Specialist will be responsible for reviewing documentation, activity summaries, and correspondence to obtain notes related to denials. They will also review claim and billing history to isolate any denials related to coding, billing, timely filing, missing or incorrect information. The successful candidate will work closely with our team to develop and implement strategies to improve denial rates and ensure compliance with regulatory requirements. Responsibilities: Review documentation, activity summaries, and correspondence to obtain notes related to denials. Review claim and billing history to isolate any denials related to coding, billing, timely filing, missing or incorrect information. Work on medical necessity and identify the root cause of the denial. Review medical records and obtain necessary information to support medical necessity. Review for additional information such as insurance cards, face sheets, detailed bills, EOBs, UB04s, auth approvals, and denial letters. Compose an appeal letter if appealing the denial. Competencies, Skills, and Other Requirements: Unflinching integrity and personal work ethics. A self-starter who strives for self and team excellence. A flair for client satisfaction. Attention to detail and concern for accuracy. Excellent time management skills and multi-tasking ability. Excellent team player. Compliant to rules and regulations.

Creado: Jue, 01 de Ene de 1970