Clinical Appeals Specialist LPN/RN - PRN - Work From Home
Patient Account Services - Palm Harbor - Palm Harbor, FL

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Job Summary – Handles appeals requiring clinical input or interpretation

Key Responsibilities
  • Monitor insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons
  • Identify coding or clinical documentation issues and work to correct the errors in a timely manner
  • Identify problem accounts and escalates as appropriate
  • Update the patient account record to identify actions taken on the account
  • Work with guarantors to secure payment on account balances outstanding for clinical reasons
  • Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
  • Other duties as assigned

                                      Knowledge, Skills & Abilities
                                      • Communication - communicates clearly and concisely, verbally and in writing
                                      • Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
                                      • Interpersonal skills – able to work effectively with other employees, patients and external parties
                                    • PC skills – demonstrates proficiency in Microsoft Office applications and others as required
                                    • Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
                                    • Basic skills – able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
                                    • Clinical skills – ability to read and interpret medical records
                                    • EDUCATION
                                      • Associate’s Degree preferred

                                      • At least one year case management experience required
                                      • Relevant education may substitute experience requirement
                                      CERTIFICATE/LICENSE – Current State RN or LPN License preferred