Clinical Denials Specialist

2 days ago


Greenville, South Carolina, United States Vidant Health Full time
About the Role

Vidant Health is seeking a skilled Clinical Denials Specialist to join our team. As a key member of our appeals team, you will be responsible for reviewing denied claims and ensuring timely and accurate appeals to maximize reimbursement and minimize recoupment.

Key Responsibilities
  • Review medical records to determine whether each case should be appealed, downgraded, or referred to physician advisors
  • Write comprehensive and concise appeals utilizing appropriate screening tools and payer policies
  • Perform timely medical record audit reviews for accuracy
  • Track all denial/appeal activity and identify trends
  • Review response letters from insurance carriers and follow up as necessary
Requirements
  • Bachelor of Science in Nursing or Associate Degree in Nursing with 10 years of experience in Case Management, Utilization Review, or Clinical Documentation Improvement
  • 5 years of related work experience within Case Management, Utilization Review, or Clinical Documentation Improvement
What We Offer

Vidant Health offers a competitive salary and benefits package, as well as opportunities for professional growth and development.



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