What are the responsibilities and job description for the Clinical Appeals Auditor position at Recruiting Solutions?
Clinical Appeals Auditor | Responsibilities and Metrics
Are you looking for your next challenge? The Virtual Business Office Associates is the perfect balance of a diverse and growing workforce that still feels like home. If you are an A / R Specialist with experience working denied claims from beginning to end, come join our best in KLAS Extended Business Office today!
Hiring remotely from : FL, GA, TX, NC, SC, VA, KY, AL.
FLSA Status : Exempt
What's in it for you :
Add to your portfolio by joining our fast-paced, exciting, diverse and inclusive work environment
Endless growth opportunities and continuous professional development
You'll support one of the largest professional services firms in the world, with access to cutting edge automation and AI technologies to enhance your workday experience
A permanent position with our company that offers stability and growth opportunities
A flexible schedule that allows you to enjoy a work life balance, and leave early on Friday's
Use the latest EMR systems and utilize full portal access for the insurance payers worked
Comprehensive employee benefits
What you'll do :
Manages denials and appeals in a manner that diligently investigates every unpaid claim
Assesses the need for formal appeals of all clinical denials
Appeals the rejections appropriately as per the appeals process for the provider contract
Reviews and audits clinical documentation to ensure its sufficiency
Utilizes various resources in order to understand the appeals and denials criteria; searches for supporting clinical evidence to support appeal arguments when existing resources are unavailable
Adheres to all appeal timelines as prescribed by payer agreements
Employs the use of different systems to evaluate clinical and financial data
Uncovers trends related to different cases and various insurance carriers; maintains related data and monitors payer response to appeal activity
Provides information to leadership on patterns or trends associated with denials and appeals
What you'll need :
Minimum Degree : Bachelor's degree or higher in nursing; current RN licensure
Minimum Years of Experience : 5 years of experience in a clinical and business setting
Software / Systems Experience : Interqual and / or Milliman
