Medical Necessity Denial Specialist
7 days ago
We are seeking a highly skilled Clinical Denial Specialist to join our team at Yale New Haven Health. As a key member of our revenue recovery team, you will play a critical role in reducing financial liability and recovering lost revenue for coding and medical necessity denials.
Key Responsibilities- Denial Research and Analysis: Conduct thorough research on payer denials related to medical necessity, coding, and other factors to identify opportunities for appeal.
- Appeal Letter Preparation: Compile supporting documentation and draft detailed, customized appeal letters to payers in accordance with Medicare, Medicaid, Commercial, and YNHHS policies and procedures.
- Appeal Tracking and Follow-up: Ensure timely receipt of appeals and follow up with payers until determination is made.
- Denial Trend Identification and Resolution: Identify payer denial trends, triage discrepancies, and collaborate with internal teams to resolve issues and prevent future denials.
- Metrics Reporting and Analysis: Track key denial data, develop and maintain metrics reports, and present data to organizational committees as required.
- Communication and Collaboration: Communicate directly with payers, coordinate meetings with contracting and payers as needed, and perform other duties as assigned.
- Education: Two (2) years of college or equivalent with familiarity with medical terminology and anatomy.
- Experience: Three to five years of coding and/or billing experience required, with previous experience with governmental and managed care denial/appeal process, including familiarity with RAC.
- Certifications: Certified Coding Specialist (CCS), Certified Coding Specialist Physician based (CCS-P) certification through the American Health Information Management Association (AHIMA) and/or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) through American Academy of Professional Coders (AAPC) or similar certification is required, or must be obtained within a year of hire.
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Clinical Denial Specialist
7 days ago
New Haven, Connecticut, United States Yale New Haven Health Full timeJob SummaryWe are seeking a highly skilled Clinical Denial Specialist to join our team at Yale New Haven Health. As a key member of our revenue recovery team, you will be responsible for reducing financial liability and recovering lost revenue for coding and medical necessity denials.Key ResponsibilitiesDenial Research and Analysis: Conduct thorough research...
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