Department: HS DENIAL MITIGATION
Job Summary: Reviews clinical information and supporting documentation for acute care inpatient Part A services to determine appeal
action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned.
One or more of the following: - RN with 5 years experience
in healthcare acute care hospital setting and one of the
following - 3-5 years payer environment performing
activities such as auditing, patient billing, and/or denial
management. - 3-5 years Case Management experience
RN, 5 years clinical experience in a clinical
Five years clinical experience and 3-5 years
case management or denial management
Ability to type and/or key accurately and
have strong organizational skills.
Nursing, Case Management or Denial Management
Familiarity with electronic medical records and
claims/practice management systems.
Requires critical thinking and judgement
and must demostrates the ability to
appropriately use standard criteria
established by payers.
Excellent interpersonal, communication, and writing skills.
Advanced computer literacy skills. Strong analytical and
problem solving skills with an ability to understand and
troubleshoot interconnected data and denial processes.
Excellent communication skills. Advanced
computer literacy skills with the ability to
type and key accurately.
CCM, CCS, RN