Clinical Denial Specialist

Job not on LinkedIn

🔥 6 minutes ago

🇺🇸 United States – Remote

💵 $67.1k - $92.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Franciscan Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1875

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Franciscan Health is a healthcare organization committed to providing high-quality medical care grounded in the Franciscan tradition. They offer a range of medical services, including clinical and allied health, home health and hospice, nursing, physicians and advanced practice providers, and non-clinical and administrative roles. With a focus on embracing the values of St. Francis to care for those in need, they provide a supportive and fulfilling work environment for their employees, emphasizing a mission of compassion and community engagement. Franciscan Health is dedicated to offering a variety of employment opportunities across different medical specialties and locations.

📋 Description

• Function as a hospital liaison to appeal denied Medicare, Medicaid, Managed, and Commercial insurance claims • Conduct detailed retrospective reviews of patient medical records in EPIC • Analyze and compile data for additional documentation requests and claim denials • Develop reports • Review governmental contractor responses • Identify root causes of potential denials and collaborate with departments and Clinical Documentation Integrity on process improvement • Write and timely file appeals • Audit medical documentation for adherence to insurance and CMS guidelines for inpatient and observation services • Establish medical necessity letters using inpatient criteria

🎯 Requirements

• Bachelor's degree in Nursing or Associate degree in Nursing with 5 years of nursing experience required • Active Indiana RN license required • 3 years of denial related experience required • 5 years Nursing or Case Management preferred • Knowledge of inpatient criteria • Knowledge of Medicare, Medicaid, Managed, and Commercial insurance requirements • Experience with EPIC and medical record review • Ability to work Monday–Friday, 8:00 a.m.–4:30 p.m. EST

🏖️ Benefits

• Comprehensive benefit offerings for eligible employees

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