Remote Denials Prevention Clinician

Job Summary

Analyzing denials and appeal outcomes, the full-time Remote Denials Prevention Clinician will utilize clinical and administrative skills to reduce first pass denials through effective collaboration, staff education, and process improvement initiatives.

Key responsibilities

• Maintain the integrity of information in appeals and review a high volume of written appeals for medical accuracy
• Research payer denials and make recommendations for workflow revisions to improve efficiency and reduce denials
• Present case studies and recommendations to clients and stakeholders while identifying opportunities for process improvement

Required qualifications

• Bachelor's degree in a health-related field, or two years of relevant experience in lieu of a degree; LPN or RN preferred
• Two years of recent experience in hospital case management, prior authorization, or utilization management
• Experience in medical chart review and claim-related appeal writing preferred
• Familiarity with medical and insurance terminology, CPT, ICD coding structures, and billing forms
• Proficiency in Microsoft Office Suite and experience with MCG and/or InterQual guidelines preferred