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Company:
Accuity
Posted: June 15, 2024
Job Type
Full-time
Description
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 bachelor's 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
Full-time
Description
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 bachelor's 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
Read the full job description and apply online on the recuiter's web-site
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