Clinical Appeals Writer, Medical NecessityIntersect Healthcare is seeking an Clinical Appeals Writer, specializing in Medical Necessity.
The Appeal Writer reports to the Clinical Director.
Essential Skills and Responsibilities:
- Works from home under the direction of the Vice President of Audit & Appeal Services.
- Conducts medical record review and subsequent consultation regarding opportunity for revenue recoupment.
- Provides well written appeal arguments based on clinical evidence within the medical record and evidence-based literature.
- Responsible for proofreading and editing prior to submission.
- Provides Root Cause analyses to educate and benefit clients.
- Understands and utilizes Veracity software.
- Utilizes AppealMaster’s templates according to design.
- Completes all Task assignments within due dates.
- Ensures compliance with HIPAA regulations, including strict clinical confidentiality standards of practice.
- Attends bimonthly evening educational conference call updates.
- Other duties as assigned.
- 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: Able to synthesize even poorly documented medical records into a compelling written argument to overturn the reimbursement denial using carefully gleaned evidence found throughout the medical record.
- Organized: Disciplined time management skills.
- Able to follow policies and procedures.
- Communication: Able to keep supervision informed of issues and concerns as they arise. Provides at least 2 weeks prior notice of planned leaves. Communication involving emergency situations handled as soon as possible.
- Commitment to quality: Able to complete work accurately and timely; continuously striving to improve personal work product. Able to self-edit to ensure flawless grammar and spelling.
- Graduate of accredited Nursing, Medical, or Allied Health Discipline program with appropriate corresponding licensure.
- Knowledge and experience with the use of evidence based inpatient 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.
- Knowledge of appeal writing, specifically in medical necessity
Please submit your resume.
Intersect Healthcare and AppealMasters is an Equal Opportunity Employer and we’re proud to be building a diverse workforce.