Stanford Health Care
Clinical Government Audit Analyst & Appeal Specialist II (RN) (Remote)
Stanford Health Care, Myrtle Point, Oregon, United States, 97458
Overview
Employer Industry: Healthcare Services
Compensation and Benefits
Salary up to $83.16 per hour
Opportunity for career advancement and growth within the organization
Engage in meaningful work that contributes to the financial health of the organization
Collaborative environment working with clinical staff and coding professionals
Involvement in developing appeal strategies and audit tools
Commitment to diversity and equal opportunity in the workplace
What to Expect (Job Responsibilities)
Conduct thorough analyses of denials, ensuring accurate coding and identifying overpayments and underpayments
Independently compose professional appeal letters to payors, ensuring compliance with relevant guidelines
Develop comprehensive appeal strategies and provide thoughtful appealability scores for each denial
Collaborate with clinical teams to gather necessary information to support appeals
Stay updated on healthcare regulations and participate in developing policies and procedures for the Denials Management Department
What is Required (Qualifications)
Bachelor’s degree in a work-related discipline/field from an accredited college or university
Minimum two (2) years of progressive denials and appeals experience
Strong communication skills, both written and verbal
Knowledge of medical and insurance terminology, coding structures, and billing forms
Proficiency in computer systems, specifically EPIC and 3M, as well as Microsoft Office Suite
How to Stand Out (Preferred Qualifications)
Experience with coding, clinical validation, and medical necessity for inpatient stays
Certification in coding (CCA, CCS, COC, CDIP, or CCDS) or RN state licensure within 180 days
Ability to apply critical thinking skills to identify patterns and trends
Demonstrated flexibility in responding to new challenges and evolving healthcare regulations
Extensive writing capabilities and efficiencies
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Compensation and Benefits
Salary up to $83.16 per hour
Opportunity for career advancement and growth within the organization
Engage in meaningful work that contributes to the financial health of the organization
Collaborative environment working with clinical staff and coding professionals
Involvement in developing appeal strategies and audit tools
Commitment to diversity and equal opportunity in the workplace
What to Expect (Job Responsibilities)
Conduct thorough analyses of denials, ensuring accurate coding and identifying overpayments and underpayments
Independently compose professional appeal letters to payors, ensuring compliance with relevant guidelines
Develop comprehensive appeal strategies and provide thoughtful appealability scores for each denial
Collaborate with clinical teams to gather necessary information to support appeals
Stay updated on healthcare regulations and participate in developing policies and procedures for the Denials Management Department
What is Required (Qualifications)
Bachelor’s degree in a work-related discipline/field from an accredited college or university
Minimum two (2) years of progressive denials and appeals experience
Strong communication skills, both written and verbal
Knowledge of medical and insurance terminology, coding structures, and billing forms
Proficiency in computer systems, specifically EPIC and 3M, as well as Microsoft Office Suite
How to Stand Out (Preferred Qualifications)
Experience with coding, clinical validation, and medical necessity for inpatient stays
Certification in coding (CCA, CCS, COC, CDIP, or CCDS) or RN state licensure within 180 days
Ability to apply critical thinking skills to identify patterns and trends
Demonstrated flexibility in responding to new challenges and evolving healthcare regulations
Extensive writing capabilities and efficiencies
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