Clinical Appeals Specialist (Patient Accounting)- Remote
Additional Position Details: FTE: 1.000000 | Full Time | Primarily Mon - Fri / 8AM - 5PM
Please Note: This is a remote position. Candidates will be required to have reliable broadband internet and personal cell phone service. Remote work may include online training and working day-to-day operations during Pacific Standard business hours.
Starting Wage: $36.79-$50.59 per hour, depending on experience

POSITION SUMMARY

The Clinical Appeals Specialist is responsible for managing clinical denials by conducting a comprehensive review of clinical documentation and formulating a timely and defensible written response based on clinical documentation, evidence-based medical necessity criteria, physician documentation, and medical policies of the payor. Communicates identified denial trends and patterns to the Manager of Patient Accounting, the Director of Revenue Cycle, and all applicable patient accounting leaders. Works to review, evaluate, and improve the enterprise clinical denial and appeal process. At the direction of the Manager of Patient Accounting, this individual will orchestrate education and other performance improvement initiatives to impact clinical quality, improve efficiency, and mitigate lost revenue related to medical necessity denials.

QUALIFICATIONS

• Minimum 3 years of Clinical RN experience, including 1 year of Denial Management OR Case Management OR related experience AND 1 year of current experience with reimbursement methodologies, required
• RN: Registered Nurse licensed by the Oregon State Board of Nursing OR RN (Registered Nurse) with an active license in a state approved for remote work in this position, required
• Bachelor’s degree in Nursing or allied health field or equivalent, preferred
• Experience preparing appeals for clinical denials, preferred
• CCDS: Certified Clinical Documentation Integrity Specialist by ACDIS, preferred
• CCM: Certified Case Manager, preferred

Please refer the Job description for details