Specialist-Denial I

Reviews clinical information and supporting documentation for outpatient or Part B services to determine appeal action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned. Responsibilities • Reviews, assesses, and evaluates all communications received in order to optimize reimbursement. • Evaluates clinical information and supportive documentation prior to initial appeal action in order to optimize reimbursement and utilization of resources. • Prepares response to appeal/request for information based on supporting clinical information in order to enhance reimbursement and maximize customer satisfaction. • Compiles, analyzes, and distributes necessary clinical and financial information and presents reports to other healthcare providers in order to improve performances, and increase awareness of resources consumed related to reimbursement. • Completes assigned goals. Education Minimum: Ability to type and/or key accurately and have strong organizational skills. Experience Preferred: 3 years clinical experience and at least or 3 years payer experience. Minimum: 2-5 years clinical experience in a clinical care setting. Licensure, Registration, Certification Preferred: RHIT; LPN;RN Special Skills Minimum: Excellent communication skills. Advanced computer literacy skills with the ability to type and key accurately. Training Minimum: Requires critical thinking and judgement and must demostrates the ability to appropriately use standard criteria established by payers.