Specialist-Denial I

Specialist-Denial I Memphis, Tennessee, United States

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Specialist-Denial I Job ID: 39524 Job Category: Billing, Claims and Revenue Work Type: Full Time Work Schedule: Days Department: Denial Mitigation Facility: BMHCC System Services Location: Memphis, TN

OverviewJob Summary 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.

Job 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.

ExperienceMinimum Required

• 3 years clinical experience and at least 3 years payer experience.

EducationMinimum Required

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

TrainingMinimum Required

• Requires critical thinking and judgement and must demonstrates the ability to appropriately use standard criteria established by payers.
• Experienced in working in an outpatient or inpatient clinical setting.
• Familiarity with electronic medical records and claims practice management systems.

Special SkillsMinimum Required

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

LicensurePreferred

• RN, LPN, or RHIT preferred (not required).

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