What are the responsibilities and job description for the Clinical Appeals Specialist Trainee - PHMI Medical Records position at Prime Healthcare?
Responsibilities
The Clinical Appeals Specialist Trainee (CAST) is responsible for performing denial reviews for inpatient & outpatient accounts bordering on medical necessity and DRG downgrades as applicable. He/She will undergo training in reviewing denial letters for Medicare, Commercial and Third-Party payors, interpreting payer denial rationales, crafting custom appeal letters, data entry of audit recommendations, and timely turnaround on appeal letters. CAST will learn to identify payer denial trends and communicates findings to appropriate management teams. He/She will perform other duties as assigned.
Qualifications
EDUCATION, EXPERIENCE, TRAINING
Required Qualifications:
1. Medical Graduate or Physician Assistant Degree.
2. Excellent written and verbal communication skills. Excellent critical thinking skills.
3. Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred
4. Basic computer knowledge/experience
Preferred Qualifications:
1. Master’s degree in Healthcare Administration, Business, Public Health or related healthcare field.
2. Minimum of two years’ experience with ICD-10-CM and CPT coding in an acute care setting preferred
3. Certified Coding Specialist (CCS)
4. Clinical experience in acute care setting preferred.
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf
