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Clinical Appeals Specialist (Patient Accounting)- Remote
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Job Description
- Req#: 22458
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $50.59 per hour, depending on experience
- Benefit from health plans focusing on health and wellness, including medical, dental, and vision, beginning within 30 days of hire
- Plan for your future with a retirement package that includes up to 6% employer contribution
- Experience a healthy work-life balance with generous earned time off (ETO)
- Continue to enhance your education through tuition reimbursement and repayment plans
- Flexibility of remote work, including online training and day-to-day operations during Pacific Standard business hours
What to Expect (Job Responsibilities):
- Manage clinical denials by conducting comprehensive reviews of clinical documentation
- Formulate timely and defensible written responses based on clinical documentation and medical necessity criteria
- Communicate identified denial trends and patterns to relevant leadership and patient accounting teams
- Review, evaluate, and improve the enterprise clinical denial and appeal process
- Orchestrate education and performance improvement initiatives to enhance clinical quality and efficiency
What is Required (Qualifications):
- Minimum 3 years of Clinical RN experience, including 1 year of Denial Management or Case Management experience
- 1 year of current experience with reimbursement methodologies
- RN: Registered Nurse licensed by the Oregon State Board of Nursing or another state approved for remote work
- Bachelor's degree in Nursing or allied health field or equivalent
- Experience preparing appeals for clinical denials
How to Stand Out (Preferred Qualifications):
- CCDS: Certified Clinical Documentation Integrity Specialist by ACDIS
- CCM: Certified Case Manager
- Additional experience in denial management or related areas
#HealthcareServices #ClinicalAppeals #RemoteWork #CareerGrowth #CompetitiveSalary
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