Murray-Calloway County Hospital
Clinical Denials and Appeals Specialist-Full Time- Business Office
Murray-Calloway County Hospital, Murray, Kentucky, United States, 42071
Clinical Denials And Appeals Specialist
Under the general supervision of the Director of Revenue Cycle, the Clinical Denials And Appeals Specialist performs advanced level work related to Clinical Denial Management. The Clinical Denials And Appeals Specialist will be 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. The Clinical Denials And Appeals Specialist will also communicate identified denial trends and patterns to the Director, UM Department, and HIM Department. This individual will work to review, evaluate and improve the organizations clinical denial and appeal process as well. Minimum Education Bachelor's Degree in Nursing or in another Clinical Practice field preferred but not required Minimum Work Experience 3-5 years in Clinical RN or LPN experience including 2 years of Denial Management, Case Management, or related experience 1-2 years of experience with reimbursement methodologies Required Skills Must have experience with InterQual and/ or Milliman Disease Management Ideologies Candidate with strong coding background would be considered Required Licenses Current RN or LPN License preferred Certification in Clinical Documentation Improvement Eligible Benefits: Medical Benefits with EXCELLENT premiums Paid Life Insurance Paid Time Off Bereavement Tuition Reimbursement Screening Requirements: Drug Screen Tuberculosis Test Background Check Physical Exam Respirator Fit Current flu vaccination Our Mission: To improve the lives of those we serve by providing outstanding care and services through our confident, compassionate and exceptional healthcare professionals Our Vision: To be chosen by our community and expanded service region based on proven outcomes as the trusted provider to care for their families, friends and neighbors Our Values: Compassion, Competence, Excellence, Respect, Integrity
Under the general supervision of the Director of Revenue Cycle, the Clinical Denials And Appeals Specialist performs advanced level work related to Clinical Denial Management. The Clinical Denials And Appeals Specialist will be 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. The Clinical Denials And Appeals Specialist will also communicate identified denial trends and patterns to the Director, UM Department, and HIM Department. This individual will work to review, evaluate and improve the organizations clinical denial and appeal process as well. Minimum Education Bachelor's Degree in Nursing or in another Clinical Practice field preferred but not required Minimum Work Experience 3-5 years in Clinical RN or LPN experience including 2 years of Denial Management, Case Management, or related experience 1-2 years of experience with reimbursement methodologies Required Skills Must have experience with InterQual and/ or Milliman Disease Management Ideologies Candidate with strong coding background would be considered Required Licenses Current RN or LPN License preferred Certification in Clinical Documentation Improvement Eligible Benefits: Medical Benefits with EXCELLENT premiums Paid Life Insurance Paid Time Off Bereavement Tuition Reimbursement Screening Requirements: Drug Screen Tuberculosis Test Background Check Physical Exam Respirator Fit Current flu vaccination Our Mission: To improve the lives of those we serve by providing outstanding care and services through our confident, compassionate and exceptional healthcare professionals Our Vision: To be chosen by our community and expanded service region based on proven outcomes as the trusted provider to care for their families, friends and neighbors Our Values: Compassion, Competence, Excellence, Respect, Integrity