Clinical Denials
1 month ago
Ensure all denied claims are accurately worked and appealed to obtain maximum reimbursement and minimize recoupment.
Combine clinical, business and regulatory knowledge and skills to reduce financial risk and exposure caused by concurrent and retrospective denial of payment for rendered services.
Utilize MCG guidelines, Medicare's 2-midnight rule, and any other payer specific requirement for inpatient, along with the appropriate payer medical policy or NCD/LCD for outpatient services. Responsibilities Reviews Medical Record and determines whether each case should be appealed, downgraded, or referred to physician advisors (PAs).
Downgrading would occur if PA indicated in notes or no clinical justification noted in medical record.
Appeals would be written if related to deaths, AMAs, auths due to payer error or when already received.
Appeal referral when a physician is required to support medical necessity.
A medical record review may include investigating a patient's medical and treatment history or obtaining external medical records necessary to support the hospital medical record. Minimum Requirements Bachelor of Science in Nursing.
5 years of related work experience within Case Management, Utilization Review, or Clinical Documentation Improvement.
In place of a Bachelor's in Nursing, an Associate Degree in Nursing (RN) is acceptable with an accompanying 10 years experience in Case Management, Utilization Review, or Clinical Documentation Improvement. General Statement It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position. Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification. We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
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Clinical Coordinator
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Greenville, United States Vidant Health Full timeJob Description ECU Health About ECU Health ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers...
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Denials Specialist
1 month ago
Greenville, United States Vidant Health Full timeJob Description ECU Health About ECU Health ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers...
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Greenville, United States Vidant Health Full timeJob Description ECU Health About ECU Health ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers...
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Clinical Denials
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Greenville, NC, United States ECU Health Full timeECU Health Read on to find out what you will need to succeed in this position, including skills, qualifications, and experience. About ECU Health Medical Center ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School...
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Clinical Denials
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Greenville, United States ECU Health Full timeECU HealthRead on to find out what you will need to succeed in this position, including skills, qualifications, and experience.About ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of...
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Clinical Denials
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Greenville, United States ECU Health Full timeECU HealthAbout ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides...
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Greenville, United States ECU Health Full timeECU HealthAbout ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides...
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Clinical Denials
2 weeks ago
Greenville, United States ECU Health Full timeECU HealthAbout ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides...
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Clinical Denials
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Greenville, United States ECU Health Full timeECU HealthAbout ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides...
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Clinical Denials
2 weeks ago
Greenville, United States ECU Health Full timeECU HealthAbout ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides...
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Clinical Denials
2 weeks ago
Greenville, United States ECU Health Full timeECU HealthAbout ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides...
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Clinical Denials
1 month ago
Greenville, NC, United States ECU Health Full timeECU HealthAbout ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides...
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Clinical Denials
2 weeks ago
Greenville, NC, United States ECU Health Full timeECU HealthAbout ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides...
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Greenville, NC, United States ECU Health Full timeECU Health About ECU Health Medical Center ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and...
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Greenville, NC, United States ECU Health Full timeECU Health Read on to find out what you will need to succeed in this position, including skills, qualifications, and experience. About ECU Health Medical Center ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody...
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