Um & Clinical Denials Assistant

RESPONSIBLE FOR:
The purpose of this role is to provide support to the Utilization Management Nurse and RN Appeals Writer in the Care Management Department. This role will help to prevent clinical denials related to lack of clinical, lack of authorization and untimely notifications. This role will work closely with the physician to ensure that peer-to-peer reviews are completed in a timely manner. This role will be responsible for investigating root cause of clinical denials and documenting them in Epic and follow-up of appeal outcome.

Requirements

MINIMUM EDUCATION REQUIRED:
High School diploma, or the equivalent such as the General Education Development (GED)

MINIMUM EXPERIENCE REQUIRED:
Three years of experience in either hospital billing, Care Management, utilization review or commercial / managed care. Demonstrable detailed levels of knowledge of commercial, government payer and/or denial rules are required. Demonstrable detailed levels of knowledge of medical terminology required

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
None

ADDITIONAL QUALIFICATIONS:
Associates degree in human services/healthcare related field, or coding preferred

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