Clinical Denial Specialist

Clinical Denial SpecialistRevenue CaptureFranciscan Alliance24 Joliet St

Dyer, IN 46311DaysFull-TimeHigh School Diploma/ GED RequiredWHAT WE NEEDA persistent person who can find the answersWHO WE ARE LOOKING FORHigh quality health care is both a calling and a business. And the business side dictates reviewing clinically denied cases, determining if appeals can be made, and providing follow-up. Bottom line: this job is important for back-end operations. Think you’re up for the job?Are you timely and accurate? Are you detail-oriented? Do you love knowing that you’re an integral part of the team? We’ve got a great place to put your skills to work.WHAT YOU WILL DOIdentify underlying root causes for potential denials and work closely with departments, Clinical Documentation Integrity to reduce denials.

Review and analyze governmental denial rationales and provide appropriate medical necessity appeal services.

Write appropriate appeal letters based upon professional clinical judgment for medical necessity and other reasons for claim denial.

Review governmental contractor’s response letter and extract pertinent information from the respective medical record for precise appeal document creation.

Audit records and communicate with the facility regarding missing or insufficient medical documentation.

Audit medical documentation for adherence to insurance and CMS guidelines relating to inpatient/ observation services, or other denial issues.

WHAT IT TAKES TO SUCCEEDPrior Revenue Cycle experience.

Knowledge of billing and collection systems.

Identify and understand patterns and relationships between numbers.

Database software.

Critically evaluate and analyze information in written materials.

Solve problems by analyzing information and using logic to address issues and problems.

Time management.

Effectively communicate verbally and in writing.

WHAT WE'RE LOOKING FORExperience2 years of Revenue cycle requiredEQUAL OPPORTUNITY EMPLOYERIt is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.Franciscan Alliance is committed to equal employment opportunity.Dyer, IN, US, 46311Full-TimeemploymentType: Full-TimeDaysDyerIN4631124 Joliet St