What are the responsibilities and job description for the Clinical Appeals Specialist position at St Lukes Health System (Boise ID)?
Overview
At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.
What You Can Expect:
Under limited supervision, the Clinical Appeals Specialist 2, is responsible for managing client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
- Reviews patient medical records and utilizes clinical and regulatory knowledge and skills as well as knowledge of payer requirements to determine why cases are denied and whether an appeal is required.
- Prepares appeal arguments, using pre-existing criteria sets and/or clinical evidence from existing library of clinical references and/or regulatory arguments, as necessary.
- Acts as a resource to the verifiers on documentation, coding & clinical account review.
- Maintains knowledge of state and federal guidelines, advisory opinions, updates, bulletins, and other communication related to the revenue cycle and provide updates to appropriate individuals in the organization.
- Coordinates and integrates data from multiple sources to provide and maintain a single reporting location that reflects clinical denials and appeals activity.
- Recommends improvements and modifications to departmental operating procedures to maximize operating efficiency and reimbursement.
- Performs other duties and responsibilities as assigned.
Qualifications:
- Education: Bachelor's Degree or 7 years relevant experience in lieu of degree.
- Experience: 3 year's experience.
What’s in it for you
At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.
