Clinical Denial/Utilization Management Assistant

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $17 - $27 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Carle Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

⚕️ Healthcare Insurance

🏥 Healthcare

📚 Education

Healthcare Insurance • Healthcare • Education

Carle Health is a comprehensive healthcare provider dedicated to managing the health needs of its community. Offering a wide range of services, from general medical care to specialized treatments in oncology, cardiovascular, pediatrics, and women's health, Carle Health emphasizes quality patient care and community health initiatives. Additionally, it supports education and research through the Carle Illinois College of Medicine and engages in community health programs that aim to improve overall well-being.

📋 Description

• Provide support to the Clinical Denial Management and Utilization Review teams • Maintain and utilize EPIC work queues driving payer notification and authorization for patient stays • Communicate with payers via telephone, fax, or email • Ensure clinical requests are sent accurately, thoroughly, and in a timely manner • Support the clinical denial appeal process before appeal creation and after appeals are sent to payers • Track key information throughout the life span of clinical appeals • Communicate with teams to ensure denial letters are addressed promptly • Review payer denials and document them in Dragonfly, the EMR, and/or tracking tools • Submit appeal documents accurately and timely • Organize and maintain appeal documents, databases, and records • Review appealed cases and notify the Clinical Denials Management team of new findings • Contact insurance providers when additional information is needed • Gather data for reporting • Screen incoming communications related to clinical denials and direct them appropriately • Perform assigned projects, reviews, and reports • Interact with hospital, provider, and financial staff and provide direction as necessary

🎯 Requirements

• Ability to maintain and utilize EPIC work queues • Ability to communicate with payers via telephone, fax, or email • Ability to send clinical requests accurately, thoroughly, and timely • Ability to review and document denials in Dragonfly software, EMR, and/or tracking tools • Ability to organize and maintain clinical appeal documents, databases, and records • Ability to gather data for reporting purposes • Ability to screen and direct incoming calls, faxes, and digital communications • Ability to interact with hospital, provider, and financial staff regarding determinations, appeals, and denials • Qualifications, certifications, education, and work experience are not specified

🏖️ Benefits

• Comprehensive benefits package • Equal Opportunity Employer