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Clinical Reimbursement Specialist
2 months ago
Genesis Healthcare LLC is seeking a highly skilled Clinical Reimbursement Specialist to join our team. As a Clinical Reimbursement Specialist, you will play a critical role in assisting the denial management team by conducting comprehensive analytical reviews of patient medical records.
Key Responsibilities- Conduct thorough reviews of patient medical records to identify potential denials and develop sound, sensible, and factual arguments to support appeal requests.
- Utilize clinical, regulatory knowledge, and skills to provide convincing appeal arguments and identify trends in charts that are resulting in denials.
- Identify regulatory changes or trends in appeal decisions that may be in breach of published regulations or payer policy guidelines.
- Participate in Administrative Law Judge hearings by providing testimony as necessary and request additional supporting clinical evidence to support appeal arguments when existing resources are inadequate.
- Ensure compliance with HIPAA regulations and maintain tracking records of appeals management activities in accordance with department policies.
- Provide regulatory and payer policy guidance for appeal requests at all levels and facilitate communication with designated billing/business offices in support of Denials Management process.
- Registered Nurse with significant experience in the Healthcare Industry.
- Knowledge of regulatory requirements for reimbursement and reasons for denials.
