Outpatient Clinical Denial Specialist - Remote

Employer Industry: Healthcare Services

• 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

• 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

• 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

• 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

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