Clinical Appeals Writer, Medical Necessity

Intersect 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.

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.

Intersect Healthcare and AppealMasters is an Equal Opportunity Employer and we’re proud to be building a diverse workforce.