Clinical Validation Specialist

Intersect Healthcare is seeking a Clinical Validation Specialist who will be responsible for clinical and coding appeals. This is a remote based position with a 15hr/week requirement.

Responsibilities:

  • Conducts in depth medical record reviews regarding opportunity for revenue recoupment.
  • Provides well written appeal arguments based on clinical evidence within the medical record and evidence-based literature.
  • Highlights and/or notates pertinent points in the medical record. • Responsible for proofreading and editing prior to submission.
  • Provides Root Cause analyses and Performance Improvement Recommendations to educate and benefit clients.
  • Provides a well thought out appealability score for each appeal.
  • Understands and utilizes Veracity software.
  • Utilizes AppealMaster’s templates according to design.
  • Completes all Task assignments within due dates.
  • Ensures compliance with HIPAA and company privacy regulations. • Attends meetings as requested.

Requirements:

  • Graduate of accredited Nursing, Medical, or Allied Health Discipline program with appropriate corresponding licensure
  • Knowledge and experience with the use of evidence based guidelines and criteria
  • Knowledge of third party payer requirements for reimbursable care
  • Knowledge of basic CMS rules and regulations pertaining to reimbursable care
  • Knowledge of basic clinical quality improvement principles
  • At least one year on the job experience in writing clinical validation appeals

Skills:

  • Clinical: Broad-based knowledge and experience with inpatient medical care and clinical services.
  • Analytical: Able to synthesize the worthy components within a medical record and formulate a convincing appeal based on evidence.
  • Excellent writing skills
  • Disciplined time management skills 

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