Employment Type: Full Time, 40 hours/week. In-Office – THIS IS NOT A REMOTE POSITION
Responsibilities
- Responsible for managing clinical denial practice including directly hiring. training and managing the Practice’s clinical staff. With support from Executive Team develop and implement a strategic plan for the practice and mechanisms to measure staff’s productivity and quality performance. Responsibilities will include working with the Denial Operations Manager and the Director of IT to assure that staffing is adequate, properly trained and areas to improve productivity are identified and implemented. Lastly, work with Executive Team to develop an ongoing marketing and communications program with existing clients and potential clients.
- Ensure that appeals are categorized and processed within appropriate payer, state and federal timeframes.
- Develop and/or improve tools to identify denial trends and patterns so they can be efficiently shared with existing and potential clients
- Work to review, evaluate and improve the enterprise clinical denial and appeal process.
- Supports the development of policies, procedures and training material necessary to drive process improvement and staff performance within the organization
- Identifies process gaps and trends to support client facility quality improvement
- Participates as a Hospital advocate for telephone Medicare (ALJ) hearings to facilitate denial resolution
- Provides clinical review support to Arbitration/Litigation actions as required
- Performs other duties as assigned
Requirements
- Attention to detail, strong organizational skills and self-motivated.
- Ability to independently & accurately make decisions and assimilate multiple data sources or issues related to problem solving.
- Ability to work under a timeline/deadline, prioritize work and maintain accurate records of completed work
- Strong Computer skills and Data Literacy
- Competent in Microsoft office including Excel
- Excellent English Language Communication skills – both written and verbal
- Knowledge of Medicare or Medicaid regulations
- Knowledge of and ICD10 codes preferred
- Effective time management skills, and be results driven
- Must have the ability to multitask with strong organizational skills
- Ability to work in a fast-paced environment with deadlines
- Perform other duties as may be assigned by management.
Qualifications (not sure what to write)
- A minimum of 3-5 years of experience applying both clinical and coding knowledge in writing clinical appeals
- Minimum 3 years clinical experience in an acute care setting
- Current RN license or other professional license
- Foreign Medical Graduates, MD, DO, also eligible
Job Type: Full-time
Pay: $125,000.00 - $160,000.00 per year
Benefits:
- Health insurance
- Paid time off
- Retirement plan
Schedule:
- Day shift
- Monday to Friday
Experience:
- clinical & coding in writing appeals: 2 years (Required)
Ability to Commute:
- New Hyde Park, NY 11042 (Required)
Work Location: In person