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Clinical Documentation Specialist

1 month ago

Urbana, Illinois, United States Carle Health Full time
Job Summary

Carle Health is seeking a highly skilled RN Outpatient Denial/Appeals Specialist to join our team. As a key member of our clinical review team, you will be responsible for reviewing and appealing outpatient denials, ensuring accurate and timely reimbursement for our patients.

Key Responsibilities
  • Conduct thorough clinical reviews to establish medical necessity for outpatient services
  • Develop and implement effective denial and prior authorization appeal strategies
  • Collaborate with coding and physicians to improve documentation and support medical necessity
  • Respond to insurance company inquiries and resolve medical necessity questions
  • Monitor and analyze AR and optimize collection of accounts receivable
  • Participate in system testing and development related to system upgrades and process improvements
  • Build and analyze management reports to identify patterns and trends
Requirements
  • Bachelor's Degree in Nursing
  • Registered Professional Nurse (RN) License in Illinois
  • Three years of experience in healthcare with a focus on reimbursement and/or case management
  • Proficient in Microsoft Office applications and Epic reporting tools
What We Offer

Carle Health is an equal opportunity employer and offers a competitive salary and benefits package. We are committed to providing a work environment that is inclusive and supportive of our employees' growth and development.