Clinical Denials Specialist

🔥 12 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Healthrise

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • Consulting • SaaS

Healthrise is a company dedicated to providing comprehensive healthcare solutions, focusing on revenue cycle management, electronic health record (EHR) services, and strategic consulting. With over a decade of experience, Healthrise assists health systems nationwide in achieving operational and financial success through tailored strategies. Their team of experts partners with healthcare organizations to tackle complex operational challenges and enhance efficiency, ensuring both patient and financial outcomes are optimized.

📋 Description

• Ability to analyze denial reasons and trends to identify opportunities for process improvement. • Excellent verbal and written communication skills to effectively collaborate with healthcare providers and present appeal arguments. • Keen attention to detail to ensure accurate review and analysis of denied claims and medical records. • Strong problem-solving skills to develop effective appeal strategies and overcome denial challenges. • Understanding of medical terminology, coding principles, and reimbursement guidelines to assess denial reasons and appeal opportunities. • Ability to adapt to changing payer policies, regulations, and reimbursement requirements. • Review denied claims to identify denial reasons and discrepancies. • Analyze medical records, billing documents, and payer policies to prepare appeal arguments. • Collaborate with healthcare providers to gather additional documentation and evidence for appeals. • Document appeal activities, correspondence, and outcomes for tracking and reporting purposes. • Monitor denial trends and provide feedback to revenue cycle teams to prevent future denials. • Participate in denial management meetings and contribute insights to improve denial prevention strategies. • Stay updated on payer policies, regulations, and reimbursement guidelines relevant to claim denials.

🎯 Requirements

• Bachelor's degree in healthcare administration, nursing, health information management, or a related field. • Clinical designated nurse, RN credentials (denials/CDI) • Minimum of 2-3 years of experience in healthcare revenue cycle management, medical billing, claims processing, or denial management.