Specialist-Denial I

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    "ExternalDescriptionStr": "<p>Reviews clinical information and supporting documentation for outpatient or Part B services to determine appeal action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned.</p>\n<p><br><strong>Responsibilities</strong><br>\n •&nbsp;&nbsp;&nbsp;&nbsp;Reviews, assesses, and evaluates all communications received in order to optimize reimbursement.<br>\n •&nbsp;&nbsp;&nbsp;&nbsp;Evaluates clinical information and supportive documentation prior to initial appeal action in order to optimize reimbursement and utilization of resources.<br>\n •&nbsp;&nbsp;&nbsp;&nbsp;Prepares response to appeal/request for information based on supporting clinical information in order to enhance reimbursement and maximize customer satisfaction.<br>\n •&nbsp;&nbsp;&nbsp;&nbsp;Compiles, analyzes, and distributes necessary clinical and financial information and presents reports to other healthcare providers in order to improve performances, and increase awareness of resources consumed related to reimbursement.<br>\n •&nbsp;&nbsp;&nbsp;&nbsp;Completes assigned goals.</p>\n<p><br><strong>Education</strong><br>\n  Minimum: &nbsp;Ability to type and/or key accurately and have strong organizational skills.<br>\n &nbsp;</p>\n<p><strong>Experience</strong><br>\n  Preferred: &nbsp;3 years clinical experience and at least or 3 years payer experience.<br>\n  Minimum: &nbsp;2-5 years clinical experience in a clinical care setting.<br>\n &nbsp;</p>\n<p><strong>Licensure, Registration, Certification</strong></p>\n<p> Preferred: &nbsp;RHIT; LPN;RN<br>\n &nbsp;</p>\n<p><strong>Special Skills</strong><br>\n  Minimum: &nbsp;Excellent communication skills. Advanced computer literacy skills with the ability to type and key accurately.</p>\n<p><br><strong>Training</strong></p>\n<p><br>\n  Minimum: &nbsp;Requires critical thinking and judgement and must demostrates the ability to appropriately use standard criteria established by payers.<br>\n &nbsp;</p>",
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