Location
Memphis, Tennessee
The specialist reviews clinical information and supporting documentation for outpatient or Part B services to determine the appropriate appeal action, focusing on optimizing reimbursement. Responsibilities include evaluating communications, preparing appeal responses, and compiling/presenting clinical and financial information to improve performance.
Minimum requirements include the ability to type/key accurately and possess strong organizational skills, along with 2-5 years of clinical experience in a care setting. Preferred experience includes 3 years of clinical experience and 3 years of payer experience, along with critical thinking and the ability to use standard payer criteria.
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.
Ability to type and/or key accurately and have strong organizational skills.
3 years clinical experience and at least or 3 years payer experience.
2-5 years clinical experience in a clinical care setting.
Licensure, Registration, Certification
Preferred: Rhit; lpn;rn
Excellent communication skills. Advanced computer literacy skills with the ability to type and key accurately.
Requires critical thinking and judgement and must demostrates the ability to appropriately use standard criteria established by payers.
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