Appeals Specialist/CDI Expert

MBOS

Hillside, IL

JOB DETAILS
LOCATION
Hillside, IL
POSTED
6 days ago

MBOS, established in 2003, is a subject matter expert in the healthcare revenue cycle industry and has been providing hospitals and physician practices with our expertise for over 15 years. Staffed with experts in coding, billing, denial management, CDI, and medical collections, we make it a priority in discovering the root cause of revenue cycle challenges and incorporate trend analysis with the result being a true partnership in resolving the most critical issues for our clients. As you will see, our references are well-known healthcare entities and results-driven organizations from Academic Medical Centers to Community hospitals to safety-net hospitals as well as sub-acute, ancillary, and physician practice of all sizes.

 

We are seeking a skilled and detail-oriented Appeals Specialist/CDI Expert to join our team. This role is essential for ensuring the accurate review of medical records, determining medical necessity, and managing the appeals process. The ideal candidate will have a strong clinical background, excellent communication skills, and experience with clinical documentation improvement (CDI) practices.

This role is ideal for Registered Nurses (RNs) or International Medical Graduates with Clinical Experience. It is an in-office position located in Hillside, IL. No Visa Sponsorship available. 

 

Key Responsibilities:

  • Review and analyze medical records to determine the medical necessity of services provided.
  • Prepare and submit clear, concise, and effective appeals for denied claims.
  • Utilize clinical criteria such as MCG (Milliman Care Guidelines) and InterQual to support decisions related to medical necessity.
  • Collaborate with physicians, case managers, and other healthcare providers to ensure accurate documentation and proper coding.
  • Provide guidance and support to a small team of case managers, ensuring efficient workflow and high-quality decision-making.
  • Track and monitor appeal outcomes and identify trends in denials to improve processes.
  • Generate regular reports on key performance indicators (KPIs) related to claims denials, appeals, and overall hospital trends.

Qualifications:

  • Registered Nurse (RN), International Medical Graduates with Clinical Experience
  • Experience in clinical documentation improvement (CDI), medical necessity determination, and appeals management.
  • Strong knowledge of MCG, InterQual, and other clinical guidelines.
  • Experience in medical coding, reimbursement processes, and healthcare regulations.
  • Strong communication, problem-solving, and organizational skills.
  • Ability to lead a small team and collaborate effectively across departments.
  • Proficiency in healthcare software systems and report generation.

Working Conditions:

  • Full-time position.
  • Office-based, may require hospital visits once/twice a month.

This position offers an opportunity to play a key role in improving hospital operations, ensuring proper documentation, and contributing to the overall success of the organization. If you are a dedicated and experienced professional, we encourage you to apply.

 

Benefits:

 

  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

 

Work Location: In person - Hillside, IL

 
 

About the Company

M

MBOS