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Clinical Denials Specialist
Location
United States
Posted
2 days ago
Salary
0
Seniority
Mid Level
Job Description
Clinical Denials Specialist
Healthrise
• Ability to analyze denial reasons and trends to identify opportunities for process improvement. • Excellent verbal and written communication skills to effectively collaborate with healthcare providers and present appeal arguments. • Keen attention to detail to ensure accurate review and analysis of denied claims and medical records. • Strong problem-solving skills to develop effective appeal strategies and overcome denial challenges. • Understanding of medical terminology, coding principles, and reimbursement guidelines to assess denial reasons and appeal opportunities. • Ability to adapt to changing payer policies, regulations, and reimbursement requirements. • Review denied claims to identify denial reasons and discrepancies. • Analyze medical records, billing documents, and payer policies to prepare appeal arguments. • Collaborate with healthcare providers to gather additional documentation and evidence for appeals. • Document appeal activities, correspondence, and outcomes for tracking and reporting purposes. • Monitor denial trends and provide feedback to revenue cycle teams to prevent future denials. • Participate in denial management meetings and contribute insights to improve denial prevention strategies. • Stay updated on payer policies, regulations, and reimbursement guidelines relevant to claim denials.
Job Requirements
- Bachelor's degree in healthcare administration, nursing, health information management, or a related field.
- Clinical designated nurse, RN credentials (denials/CDI)
- Minimum of 2-3 years of experience in healthcare revenue cycle management, medical billing, claims processing, or denial management.
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