Intensive Specialty Hospital -
Part-time, can work remotely
Summary :
The Clinical Appeals Specialist is primarily responsible for analyzing and interpreting hospital and MD medical records and composing a clinical appeal to the insurance company.
Responsibilities :
Compose appeals to dispute insurance adverse determinations related to medical necessity.
Construct 1st and 2nd level appeals by applying clinical rationale.
Manage assigned workload of accounts so that appeals are submitted timely in accordance with payer timeframes.
Maintain strictest confidentiality; adheres to all HIPAA guidelines / regulations.
Required Work Experience :
Clinical background, minimum RN experience
Experience in writing clinical appeals
Hospital experience
Skills :
Strong understanding of basic medical coding
Ability to develop effective working relationships with the facility and payers.
Effective written and verbal communication skills
Strong analytical, organizational, multi task and time management skills
Attention to detail
Clinical Appeals Specialist
The Clinical Appeals Specialist is primarily responsible for analyzing and interpreting hospital and MD medical records and composing a clinical appeal to the insurance company. Construct 1st and 2nd level appeals by applying clinical rationale. Experience in writing clinical appeals. Compose appeal...
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