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Appeals and Denials Specialist

Overview

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Assignment: Denial and Appeals Specialist
Specialty: IP Hospital Coding and Denials
Engagement Type (FT/PT): FT
Remote or Travel: Remote
Length of Assignment: 6 mos; ongoing
Required Credentials: CCS, RHIA, or RHIT; three years experience
Systems:

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

Additional Details:

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)
Previous experience in reviewing Inpatient Hospital based denials, writing appeal letters in all specialties a must
Does not need to have strong background in CDI since these are only coding denials for commercial payers.

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 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)

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 WHS and coding and regulatory guidelines.

Communicates well with Manager and reports unfinished assignments to the Supervisor or any barriers as they occur

Time off requests approved by WHS Manager
Location: remote,
Type: Contract
Pay: Apply for details

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