Specialist-Denial I

Specialist-Denial I in Memphis, Tennessee, United States

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Specialist-Denial I

Job ID: 39706

Job Category: Finance and Accounting

Work Type: Full Time

Work Schedule: Days

Department: Denial Mitigation

Facility: BMHCC System Services

Location: Memphis, TN

Overview

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.

Responsibilities

• Reviews, assesses, and evaluates all communications received in order to optimize reimbursement.
• Evaluates clinical information and supportive documentation prior to initial appeal action in order to optimize reimbursement and utilization of resources.
• Prepares response to appeal/request for information based on supporting clinical information in order to enhance reimbursement and maximize customer satisfaction.
• 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.
• Completes assigned goals.

Education

Minimum: Ability to type and/or key accurately and have strong organizational skills.

Experience

Preferred: 3 years clinical experience and at least or 3 years payer experience.

Minimum: 2-5 years clinical experience in a clinical care setting.

Licensure, Registration, Certification

 Preferred: RHIT; LPN;RN

Special Skills

Minimum: Excellent communication skills. Advanced computer literacy skills with the ability to type and key accurately.

Training

Minimum: Requires critical thinking and judgement and must demostrates the ability to appropriately use standard criteria established by payers.

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Equal Opportunity

Baptist is an equal employment opportunity employer and prohibits discrimination based on an individual''s race, color, religion, national origin, pregnancy, sex, age, handicap, disability (physical, visual or mental), creed, marital and veteran status, genetic information or any other category protected by federal or state law, with respect to all aspects of the employment process, including recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

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