Clinical Appeals Writer, 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.

Requirements:

• 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.

Qualifications:

• 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.

Experience:

• Knowledge of appeal writing, specifically in medical necessity

Please submit your resume.