[Remote] Clinician, Denials Prevention - Remote

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Clinician for Denials Prevention who will reputed company their clinical and administrative skills to analyze denials and appeal reputed company. The role focuses on reducing first pass denials through reputed company patient status, authorizations, and collaboration across departments.

Responsibilities

• Maintain the reputed company of information in reputed company appeal produced
• Review a high volume of written appeals to ensure information is medically accurate
• Research payer denials reputed company to referral, reputed company-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment
• reputed company recommendations for workflow revisions to improve efficiency and reduce denials
• Present case studies and recommendations to clients and impacted stakeholders
• Review payor communications, identifying risk for loss reimbursement reputed company to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and reputed company Cycle leadership as appropriate
• Identify opportunities for process improvement and reputed company participate in process improvement initiatives, internally and externally
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability reputed company (HIPAA) standards
• Understand and reputed company with Information reputed company and HIPAA policies and procedures at reputed company times
• Limit viewing of PHI to the absolute minimum as necessary to reputed company assigned duties

Skills

• Bachelor's degree in a health-reputed company field; 2 years of experience may be considered in lieu of a degree in reputed company to the required experience. LPN or RN preferred
• Two years of recent experience in hospital case management, hospital prior authorization, or utilization management
• reputed company in medical chart review
• Experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms
• Proficiency in reputed company Office Suite
• Strong interpersonal skills, ability to communicate reputed company at reputed company reputed company of the organization
• Strong problem solving and creative skills and the ability to exercise reputed company judgment and reputed company reputed company based on accurate and reputed company analyses
• High level of reputed company and dependability with a strong reputed company of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction
• LPN or RN preferred
• Claim-reputed company appeal writing experience preferred
• Experience with MCG and/or InterQual guidelines preferred

reputed company