Appeals and Denials Specialist
Found in: Lensa US P 2 C2 - 2 weeks ago
All Jobs
>
Appeals and Denials Specialist
The Appeals and Denials Specialist is responsible for triaging and writing DRG downgrades and clinical validation appeal letters for multiple clients. The Appeals and Denials Specialist will ensure appropriate action is taken within appeal deadlines. This position collaborates with the Appeals and Denials team and other departments as needed.
PRIMARY JOB RESPONSIBILITIES:
Performs review of the medical record including documentation, reports, flowsheets, and test results, applying evidence-based criteria related to DRG and clinical validation denials
Creates appeal letters utilizing the relevant information from the medical record; supported by current clinical standards and facility guidelines, evidence-based medicine, professionally recognized standards of health care, and ICD-10-CM/PCS Official Coding Guidelines
Is flexible, able to navigate multiple EHRs and other databases used by Accuity or the client, performs reviews, and submits letters of appeal per the client specific workflows
Able to prioritize cases to meet appeal deadlines
Detail-oriented
Collaborates with Accuity Physician and Accuity CDI in appropriately identified clinical denials requiring communication to the Accuity clinical review teams
Maintains clinical expertise and trends in healthcare, reimbursement methodologies and specialty areas by participating in professional organizations, seminars, and educational programs
Performs miscellaneous job-related duties as assigned
Requirements
POSITION QUALIFICATIONS:
Education :
Associate or bachelors degree in nursing or licensure in other clinical healthcare field such as MD, NP, PA.
Experience:
Minimum 3 years of CDI experience
or experience with clinical inpatient DRG Downgrades and clinical denials
Licensure and/or Credentials:
At least one of the following: MD, RN, BSN, CCDS, CDIP
Knowledge, Skills, and Abilities:
Inpatient clinical experience
Extensive knowledge of revenue cycle management and coding services
Requires good interpersonal and customer service skills
Demonstrated knowledge of ICD-10-CM, ICD-10-PCS
Motivated and self-directed
Experience with electronic health records and health information systems
Organized and able to prioritize to ensure objectives are met in a timely manner
Ability to establish and maintain cooperative working relationships with physicians and staff
Ability to use a PC in a Windows environment, including MS Word, Excel and PPT
Independent, focused individual able to work remotely
#J-18808-Ljbffr
-
Medical Biller
4 days ago
Baltimore, United States Specialist Office Full timeJob DescriptionJob DescriptionMedical Biller - A/R Baltimore, MDMUST:Experienced Medical Biller5+ years of experience in a medical billing office and resolution of rejectionsMust have collections and A/R experienceMust have strong appeals and denials experienceMust have A/R follow up experienceMust have experience handling payment refunds and AdjustmentMust...
-
Medical Biller
3 days ago
Baltimore, United States Specialist Office Full timeJob DescriptionJob DescriptionMedical Biller - A/R Baltimore, MDMUST:Experienced Medical Biller5+ years of experience in a medical billing office and resolution of rejectionsMust have collections and A/R experienceMust have strong appeals and denials experienceMust have A/R follow up experienceMust have experience handling payment refunds and AdjustmentMust...
-
Billing & Collection Specialist
4 days ago
Baltimore, United States Johns Hopkins University Full time**Specific Duties & Responsibilities** - Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal. - Conduct on-line research to locate information to resolve issues across different sub-specialties and/or relating to high-cost procedures. - Communicates with payers to resolve issues and facilitate prompt payment of claims. -...
-
Medicaid Biller
2 days ago
Baltimore, United States Trinity Supportive Housing & Consumer Services Full timeJob DescriptionJob DescriptionAs a Medicaid Biller, your primary responsibility will be to ensure accurate and timely billing and reimbursement for services provided to clients covered by Medicaid. You will be responsible for understanding Medicaid billing regulations and guidelines, verifying client eligibility, and submitting claims to Medicaid or other...
-
Ar Specialist
4 days ago
Baltimore, United States Mercy Medical Center Full timeOverview: - Under the supervision of the Manager, Physician Billing, the A/R Specialist is responsible for detailed patient account management for assigned practice groups. In the role of A/R specialist, daily work activities include: - Billing patient accounts to patients, third party, and governmental payors. - A/R follow-up and collection of physician...
-
Senior Tax Attorney I
Found in: beBee jobs US - 3 weeks ago
Baltimore, Maryland, United States State of Maryland - COMP Compliance Division Full timeIntroduction\r\rOPEN TO ALL QUALIFIED APPLICANTS\r�\rThis is a position specific recruitment. The resulting certified eligible list may be used to staff several current and future vacancies for this position/function only.\r\r�\r\r GRADE19\r LOCATION OF POSITIONBaltimore,\rMaryland\r POSITION DUTIESThis recruitment is for one current vacancy for the...
-
Entry Level Insurance Billing
2 weeks ago
Baltimore, United States Medical Account Management, Inc (MAMI) Full timeJob DescriptionJob DescriptionMedical Account Management, Inc. (MAMI) has served the healthcare industry for over 20 years providing complex claim solutions to increase cashflow for our clients.MAMI is currently looking to fill an entry level full-time position in their Workers’ Compensation billing and follow-up department . Some experience preferred but...
-
Program Manager
3 weeks ago
Baltimore, United States Caring Hands Behavioral Health Center Full timeJob DescriptionJob DescriptionSalary: SalariedCaring Hands Behavioral Health Center is seeking a program manager. We are looking to hire a Program Manager who will supervise, coordinate and oversee our OMHC and PRP programs. We are looking for highly energetic, motivated individuals who want to work on the frontlines of a growing industry. Qualifications...
-
IT Retail Specialist
2 days ago
Baltimore, United States Johns Hopkins University Full timeThis is a unique opportunity to provide customers with an exceptional retail experience within the Johns Hopkins-owned "Johns Hopkins Technology Store" selling Apple, Microsoft, and Dell products and accessories to Johns Hopkins faculty, staff, and students. As a**_ Retail IT Specialist,_** you will be responsible for delivering an outstanding technology...
-
medical care program specialist ii
Found in: beBee jobs US - 2 weeks ago
Baltimore, Maryland, United States State of Maryland - MDH Med Care Prgms - Ofc of Health Services Full timeIntroduction\r GRADE16\r LOCATION OF POSITIONMDH - Division of Participant Enrollment and Service Review\r201 W. Preston Street\rBaltimore, MD 21201\r Main Purpose of JobThis full time contractual Medical Care Program Specialist II will develop, implement, and evaluate policies,\rprocedures, and regulations for Medicaid home and community-based services...
-
Utilization Management Specialist II
Found in: Resume Library US A2 - 7 days ago
Baltimore, Maryland, United States University of Maryland Medical System Full timeJob Description Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers,...
-
Behavioral Health Specialist
1 week ago
Baltimore, United States Fayette Health and Rehabilitation Center Full timeFayette Health and Rehabilitation Center - The qualified candidate for the Behavioral Health Specialist position must have experience dealing with the mental health/behavioral population.
-
Behavioral Health Specialist
24 hours ago
Baltimore, United States Fayette Health and Rehabilitation Center Full timeFayette Health and Rehabilitation Center - The qualified candidate for the Behavioral Health Specialist position must have experience dealing with the mental health/behavioral population.
-
Utilization Management Specialist Ii
7 days ago
Baltimore, United States University of Maryland Medical System Full time**Company Description** Renowned as the academic flagship of the University of Maryland Medical System, our Magnet®-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care. Come join UMMC and discover the atmosphere where talents and ideas come together to enhance patient care and advance the...
-
Utilization Management Specialist II
4 days ago
Baltimore, United States The University of Maryland Medical System Full timeRenowned as the academic flagship of the University of Maryland Medical System, our Magnet-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care. Come join UMMC and discover the atmosphere where talents and ideas come together to enhance patient care and advance the science of nursing. Located...
-
Utilization Management Specialist II
1 week ago
Baltimore, United States University of Maryland Medical System Full timeJob DescriptionJob DescriptionCompany DescriptionRenowned as the academic flagship of the University of Maryland Medical System, our Magnet®-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care. Come join UMMC and discover the atmosphere where talents and ideas come together to enhance...
-
Utilization Management Specialist II
4 days ago
Baltimore, United States University of Maryland Medical System Full timeJob DescriptionJob DescriptionCompany DescriptionRenowned as the academic flagship of the University of Maryland Medical System, our Magnet®-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care. Come join UMMC and discover the atmosphere where talents and ideas come together to enhance...
-
Medical Billing Clerk
1 day ago
Baltimore, United States Latitude Inc Full timeJob Title: Medical Billing ClerkJob Summary: We are seeking a detail-oriented and experienced Medical Billing Clerk to join our team. The ideal candidate will have a strong background in Medicare, Medicaid, Managed Care, Commercial & Secondary insurance billing processes. The primary responsibilities include accurately processing and submitting medical...
-
Worker's Compensation Paralegal
3 weeks ago
Baltimore, United States Hassan, Hassan, and Tuchman Full timeJob DescriptionJob DescriptionDescription:The Law Offices of Hassan, Hassan & Tuchman, PA hiring a paralegal or legal assistant to assist its worker's compensation practice. Hassan, Hassan & Tuchman, PA is an established client-focused personal injury practice in the historic Bolton Hill neighborhood of Baltimore, Maryland near the Meyerhoff Symphony...
-
retirement benefits specialist i
Found in: beBee jobs US - 4 hours ago
Baltimore, Maryland, United States State of Maryland - Maryland State Retirement and Pension Systems Full timeIntroductionThe Maryland State Retirement Agency is the administrator of the Maryland State Retirement and Pension System.� The System is a multi-employer, public employees' benefit retirement system composed of twelve (12) separate retirement and pension systems with additional plan components, covering approximately 193,000 active members and more than...