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Payment Compliance - Clinical Appeals Specialist - LPN/RN

Payment Compliance - Clinical Appeals Specialist - LPN/RN

Job Description

Job Summary – Handles appeals requiring clinical input or interpretation
Key Responsibilities Monitor insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons Identify coding or clinical documentation issues and work to correct the errors in a timely manner Identify problem accounts and escalates as appropriate Update the patient account record to identify actions taken on the account Work with guarantors to secure payment on account balances outstanding for clinical reasons Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement” Other duties as assigned

Job Requirements

Knowledge, Skills & Abilities Communication - communicates clearly and concisely, verbally and in writing Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations Interpersonal skills – able to work effectively with other employees, patients and external parties PC skills – demonstrates proficiency in Microsoft Office applications and others as required Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems Basic skills – able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately Clinical skills – ability to read and interpret medical records

EDUCATION Associate’s Degree preferred

EXPERIENCE At least one year case management experience required

Relevant education may substitute experience requirement

CERTIFICATE/LICENSE – Current State RN or LPN License preferred

Job Snapshot

Employment Type Per Diem
Job Type Health Care
Education Not Specified
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
Job ID 26234-85558
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Payment Compliance - Clinical Appeals Specialist - LPN/RN

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