Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We’re powered by people, driven by technology, and dedicated to our clients and employees. If you’re looking for a collaborative and diverse culture with a great work/life balance, look no further.
Clinical Appeals Analyst
Location
United States
Posted
7 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Clinical Appeals Analyst
Revecore
Role Description Primarily responsible for thorough review of claim denials from managed care and other insurance carriers and denial management activities related to the collection of denied hospital claims. - Handle verbal and/or written appeals requiring clinical input or interpretation. - Identify coding or clinical documentation issues and work to correct and overturn denials. - Review and perform retrospective reviews, investigate and appeal all clinical level denials such as not medically necessary inpatient stays or levels of care, authorization or other denial issues. - Audit Medical Records to retrieve clinical information for appeal, prepare appeal correspondence. - Utilize online payor portals. - Review and process correspondence including approvals and denials/adjustments, demand letters and results from various levels of appeals. - Work with team to monitor, track, trend and coordinate denial resolution with payers. - Communicate with all parties in a professional manner to alert of specific problem issues. - Perform other duties as assigned. Qualifications - Working knowledge of Microsoft Office suite (Word, Excel). - Moderate computer proficiency. - Working knowledge of the revenue cycle. - Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form. - Ability to write routine correspondence (in English). - Ability to define problems, collect data, establish facts and draw valid conclusions. - Strong customer service orientation. - Excellent interpersonal and communication skills. - Commitment to company values. Requirements - Licensed as an LPN (must possess and maintain a current state nursing license). - At least 3 years of experience as a Case Manager or equivalent is desired. - At least 1 year experience with medical necessity appeals at all levels is preferred. - Bachelor's degree desirable, but equivalent job experience will be considered. - Experience using standardized clinical guidelines; InterQual experience preferred. Benefits - Paid training and incentive plans. - Medical, dental, vision, and life insurance benefits available from the first day of employment. - Excellent work/life balance. - Employee Resource Groups build community and foster a culture of belonging and inclusion. - 401(k) contributions matched. - Career growth opportunities. - 12 paid holidays and generous paid time off. Work at Home Requirements - A quiet, distraction-free environment to work from in your home. - A reliable hard-wired private internet connection that is not supplied via cellular data or hotspot is required. - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. - The workspace area accommodates all workstation equipment, related materials, and provides adequate surface area to be productive.
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