Clinical Document Improvement Specialist
Description:
Clinical Denial Appeal Nurse
1YR EXP ACCEPTED
1ST TIMERS OKAY!
3x8 schedule
DRESS CODE: BUSINESS CASUAL
Licensure: Valid Registered Nurse license in any state
Education: Graduate of accredited School of Nursing with Associate's degree
Experience: One to Two years' experience in Utilization Management and Appeals/Denials Management.
Preferred skills: Demonstrates effective communication and writing skills. Demonstrates competency in typing and data entry computer skills. Current knowledge/use of MCG evidence based clinical guidelines.
The Denials/Appeals Case Manager is responsible for responding to payer denials for billed services. Organizes and coordinates the appeal process including record review, establishment of concise clinical findings supporting appeal and justification for admission and continued stay. Is responsible for communicating with physicians, formulation of appeals letters, utilization of MCG to support inpatient admission, and maintaining log of active accounts and deadlines. May perform other duties as assigned.
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