Yale New Haven Hospital - External
Outpatient Clinical Denial Specialist - Remote
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Job Description
- Req#: 85819
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- In-depth involvement in reducing financial liability and recovering lost revenue
- Collaborative work environment with opportunities for educational development
- Engage with managed care payers to expedite reimbursement processes
- Chance to impact departmental metrics and performance positively
What to Expect (Job Responsibilities):
- Research payer denials related to medical necessity, coding, and payment delays
- Evaluate outpatient clinical denials against medical records and payer policies to assess appeal viability
- Compile supporting documentation and draft customized appeal letters for various payers
- Track receipt of appeals and follow up on submissions until a determination is made
- Identify denial trends and collaborate with internal teams to resolve issues and prevent future denials
What is Required (Qualifications):
- Two (2) years of college or equivalent with familiarity with medical terminology and anatomy
- Three to five years of coding and/or billing experience required
- Knowledge of coding, billing, and the revenue cycle
- Certified Coding Specialist (CCS), Certified Coding Specialist Physician based (CCS-P), or similar certification required or to be obtained within a year of hire
- In-depth knowledge of documentation elements within the medical record and governmental payment policies
How to Stand Out (Preferred Qualifications):
- Previous experience with governmental and managed care denial/appeal processes
- Familiarity with RAC and clinical denials for all payers
- Epic HB billing knowledge
- Expertise in analyzing and resolving coding and medical necessity payer denials
#HealthcareServices #Coding #Billing #CareerOpportunity #RevenueCycleManagement
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Yale New Haven Hospital is a 1,541-bed hospital located in New Haven, Connecticut.
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