Clinical Denials Specialist

6 days ago


Mineola, New York, United States NYU Langone Health Full time
Job Summary

We are seeking a highly skilled Clinical Denials and Appeals Specialist to join our team at NYU Langone Health. As a key member of our revenue cycle team, you will be responsible for managing clinical denials and appeals, conducting comprehensive reviews of clinical documentation, and formulating timely and defensible written responses.

Key Responsibilities
  • Manage clinical denials by conducting thorough reviews of clinical documentation and formulating written responses based on evidence-based medical necessity criteria, physician documentation, and medical policies.
  • Research and review payor denials related to referral, authorizations, level of care, and medical necessity, and formulate and submit appeal letters using relevant clinical documentation, evidence-based medical necessity criteria, and medical policies.
  • Collaborate with hospital departments, including Case Management, Health Information Management, and Clinical Documentation Improvement, to ensure accurate and timely clinical reviews.
  • Document denials and appeals in tracking tools and provide reports to leadership as needed.
  • Make recommendations for process improvements to reduce denials and improve efficiency.
  • Stay up-to-date with clinical expertise and trends in healthcare, reimbursement methodologies, and utilization management specialty areas through professional organizations, seminars, and educational programs.
Requirements
  • 3-5 years of clinical RN experience, including 2 years of denial management or case management experience.
  • 1-2 years of experience with reimbursement methodologies.
  • Bachelor's degree in Nursing or a related field.
  • Current and valid NYS Registered Nursing License.
What We Offer

NYU Langone Health offers a competitive salary range of $81,325, as well as opportunities for professional growth and development in a dynamic and supportive environment. We are an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment.



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