Appeals and Denials Specialist

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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

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