Job Description:
The Denials and Appeals Specialist follows up on denied claims from commercial and contracted payers. Performs timely and appropriate validation and follow up for assigned patients. Communicates with third party nurse reviewers or via clinical documentation inquiry any related missing, unclear or conflicting medical record documentation to clarify information, obtain needed documentation, present opportunities. Maintains appeal process from the denial stage through final denial or overturned appeal.
Required Skills:
Required Experience:
Work Experience:
Two years of experience with clinical documentation, chart reviewing, utilization review, managed care, and/or claims denials and appeals processing required.
License/Registration/Certification:
Certified Clinical Documentation Specialist preferred.
Education and Training:
Bachelor’s degree in related field required.
Click the checkbox next to the jobs that you are interested in.
Batch Testing Skill
Document Preparation Skill
UMC of El Paso, El Paso, TX
University Medical Center of El Paso, El Paso, TX