Clinical Appeal Writer

Welcome to Ovation Healthcare!

At Ovation Healthcare, we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare.

We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable.

With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions.

The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations.

Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.

We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork.

Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit

Essential Functions

Clinical appeal writer conducts the medical review activities needed to resolve and process clinical appeals and claims.

Reviews applicable medical records and assesses clinical data to investigate and resolve disputes over the medical necessity for services, approvals, pre-certifications, or other cases.

Understands and interprets applicable medical terminology, clinical procedures, regulations, and policies. Documents cases according to guidelines and standard procedures.

Prepares the documentation required for further medical review, hearings, and different appeal processes.

Responsible for submission of clinical appeals for all payors, service types, and denial reasons.

Understands reimbursement methodology impacting payment variance including : DRG downgrade, line item denials, service level, and fully denied accounts.

Work effectively with denial management team and denials analyst to appeal all denials referred.

Supporting projects and initiatives of the Denials Management Team, to include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents.

Maintains strictest confidentiality; adheres to all HIPAA guidelines / regulations.

Provides precise documentation of all actions taken on accounts worked.

Maintains client and / or position specific daily productivity and quality expectations.

Required Skills and Experience

Healthcare background is required, preferred to have knowledge in revenue cycle.

The ability to work in a fast-paced environment balancing multiple priorities and utilizing resources.

Requires the ability to interpret all aspects of a contract with an emphasis on the implementation and operational components of contract terms.

Must be a self-starter with the ability to identify, understand and research issues specific to payor contracts. This may require working with the development team on new functionality to be added if new reimbursement is introduced that is not currently available in our system.

MS Office Tools

Excellent interpersonal skills are necessary to develop strong working relationships with internal and external contact.

Experience with various electronic medical records and understand HIPAA and PHI privacy and security.

A team player, always willing to contribute to the whole of the organization.

Must be able to pass as skills assessment exam, comprehensive and background check.

Preferred Skills and Experience

Ability to function in a high intensity environment and can adapt to change in the work environment.

Exhibits effective and independent decision-making skills and can follow oral and written instruction or direction.

Strong professional written and verbal communication skills.

Knowledge of VPNs and remote desktops.

Proficient use of computers and general office-type equipment.

Hospital revenue cycle / clinical experience : 10+ years

Clinical appeals experience required

Education

Bachelors Degree

Licensure required : MD, DO, RN, or coding credentials

Work Environment Mental / Physical Activities

• Requires prolonged sitting, some bending, stooping, and stretching
• High level of manual dexterity sufficient to perform the essential functions of the position as the ability to operate a computer keyboard, photocopier, telephone, calculator, and other office equipment
• Ability to read numbers, reports, and computer terminals
• Ability to use the telephone and communicate to others in an efficient manner
• Ability to give, receive and analyze information
• Ability to formulate work plans and follow through to completion
• Ability to solve problems inherent to the position and analytical skills to assess situations
• Ability to conceptualize, plan, organize and communicate concepts
• Ability to remain distraction free for 8 hours while working remotely
30+ days ago