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Denial and Appeals Specialist
- Remote; Dayshift Hours Mon-Fri (flexibility permitted but should be requested to Manager)
- Must have RHIA or RHIT credentials
- Identifies, reviews, and responds to inpatient denials (in the form of an appeal letter if disagrees with payer or feedback to coder if agrees with payer)
- Does not need to have strong background in CDI since these are only coding denials for commercial payers.
- Previous experience in reviewing Inpatient Hospital based denials, writing appeal letters in all specialties a must
- Must be able to tell the difference between a clinical vs coding denial, as this person will forward those denials that are identified as clinical to our coding assurance department
- Must be computer savvy and able to quickly learn multiple software systems (no experience required- just the ability to learn quickly and use efficiently).
- Denials Software MRO: enter denials information for tracking
- EPIC and 3M: to review documentation
- EPIC: communicate status
- Health Logic: pull denial letters
- Word: formulate feedback to coder in the event analyst agrees with payer
- Fax: (remote) to send appeal letters
- TEAMS: tracking worksheets, logging time
- Consistently meets or exceeds productivity standards
- Denial (agree with payer): 45 mins
- Denials (disagree; appeal written): 90 mins
- Quality of work must be maintained, consistently meeting department and coding and regulatory guidelines.
- Communicates well with Manager, ie reports unfinished assignments to the Supervisor or any barriers as they occur
- Time off requests approved by Manager
Location: remote,
Type: Contract
Pay: Apply for details
1764