Additional Position Details: FTE: 1.000000 | Full Time | Primarily Mon - Fri / 8AM - 5PM
Please Note: This is a remote position. Candidates will be required to have reliable broadband internet and personal cell phone service. Remote work may include online training and working day-to-day operations during Pacific Standard business hours.
Position Summary
The Clinical Appeals Specialist is responsible for managing clinical denials by conducting a comprehensive review of clinical documentation and formulating a timely and defensible written response based on clinical documentation, evidence based medical necessity criteria, physician documentation and medical policies of the payor. Communicates identified denial trends and patterns to the Manager of Patient Accounting, the Director of Revenue Cycle and all applicable patient accounting leaders. Works to review, evaluate and improve the enterprise clinical denial and appeal process. At the direction of the Manager of Patient Accounting, this individual will orchestrate education and other performance improvement initiatives to impact clinical quality, improve efficiency and mitigate lost revenue related to medical necessity denials.
Qualifications
- Minimum 3 years of Clinical RN experience, including 1 year of Denial Management OR Case Management OR related experience AND 1 year of current experience with reimbursement methodologies, required
- RN: Registered Nurse licensed by the Oregon State Board of Nursing, OR RN (Registered Nurse) with an active license in a state approved for remote work in this position, required
- Bachelor's degree in Nursing or allied health field or equivalent,preferred
- Experience preparing appeals for clinical denials,preferred
- CCDS: Certified Clinical Documentation Integrity Specialist by ACDIS,preferred
- CCM: Certified Case Manager,preferred
Total Rewards Package
- Earn a competitive and progressive salary.
- Benefit from health plans that focus on health and wellness including medical, dental, vision and wellness beginning within 30 days of hire.
- Plan for your future with a retirement package that includes up to 6% employer contribution.
- Experience a healthy work-life balance with our generous earned time off (ETO).
- Continue to enhance your education through our tuition reimbursement and tuition repayment plans.
Explore Asante more by visiting www.asante.org/careers
At Asante We Believe That We Are Defined By Our Values - The Traits That Guide Us As We Serve Patients And The Community
Excellence - Respect - Honesty - Service - Teamwork
Asante is an equal opportunity employer. We are committed to employ and advance in employment women, minorities, qualified individuals with disabilities and protected veterans.
