Job description
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:
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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:
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Clinical background, minimum RN experience -
Experience in writing clinical appeals -
Hospital experience
Skills:
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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
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