Overview
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 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 demonstrates the ability to appropriately use standard criteria established by payers.
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