UofL Health
Medical Appeals Specialist II, Med Plaza II, 8:00a-4:30p
6 days agoWhat's your preference?
Job Description
- Req#: JR 2025-105988
Employer Industry: Healthcare System
Why consider this job opportunity:
- Opportunity for career advancement and growth within a large healthcare organization
- Contribute to transforming the health of communities through patient-centered care
- Collaborate with a diverse team of healthcare professionals
- Engage in meaningful work that impacts patient care and reimbursement processes
- Supportive and collaborative work environment focused on continuous improvement
What to Expect (Job Responsibilities):
- Conduct comprehensive reviews of clinical information to prepare strong appeal letters for denied reimbursements
- Analyze medical records to validate services and formulate clinical arguments for appeals
- Communicate effectively with physicians and multidisciplinary teams to enhance appeal submissions
- Research payor policies and perform timely follow-ups on account appeals
- Participate in denial prevention meetings to support global mitigation efforts
What is Required (Qualifications):
- Licensed/certified healthcare professional (e.g., LPN, RN, OTR) is required
- Minimum of 3-5 years of clinical experience is required
- Active, unrestricted registered clinical license is required
- Strong knowledge of medical terminology and coding rules
- Exceptional critical thinking and communication skills
How to Stand Out (Preferred Qualifications):
- Bachelor’s degree in a clinical occupation (e.g., BSN) is preferred
- Experience with appeals and denial processing is preferred
- Clinical nursing experience in a hospital setting, such as ER or Critical Care, is preferred
- Relevant certification, such as CCM or CPUM, is preferred
#HealthcareSystem #ClinicalAppeals #PatientCare #CareerGrowth #TeamCollaboration
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