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.
- 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.
- 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
- 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