Clinical Denial and Appeals Specialist (Remote based in US)
Internal Number: 2205033863
The Clinical Denial and Appeals Specialist work collaboratively with Tenet Clinical Documentation Improvement and Coding operations, Conifer Revenue Cycle, Tenet Managed Care, and Tenet Clinical Operations to effectively appeal clinical denials. The incumbent also tracks, trends, and analyzes denial information to identify improvements opportunities that reduce future denials.
Interprets clinical denials and formulates appeal letters by following the Rapid Response denial process in collaboration with appropriate Tenet and Conifer team members.
Analyzes and tracks clinical denial data to identify trends in payer denials and recommends process improvements for denial reduction. Reports clinical denial data monthly to key-stakeholders.
Performs CDI DRG Reconciliation processes.
Provides recommendations and education to CDI, Coding, and RCM leadership as a result of process and documentation improvement opportunities that are resulting in clinical denials.
Works closely with Tenetâ��s Managed Care Department to ensure alignment on payer denial trends, improvement opportunities, and supports denial meetings involving payers.
Expert level clinical appeal writing skills
Expert level ability to create clear and concise reports, and effectively communicate results
Maintain productivity standards
Must be detail oriented and can work independently and in team setting across various disciplines
Moderate skills in MS Excel and PowerPoint, MS Office
Must display excellent interpersonal skills
Ability to demonstrate initiative and discipline in time management and assignment completion
Ability to research difficult clinical denial and documentation issues and follow through to resolution
Ability to manage time effectively and prioritize assignments and projects
Ability to work in a virtual setting under minimal supervision
Bachelorâ��s degree in Nursing
5+ years of experience in a clinical field of practice
3-5 years of experience effectively writing clinical appeals and denial management
Active, current, and unrestricted RN license
Masterâ��s degree in Nursing
5+ years effectively writing clinical appeals and denial management
2+ years inpatient coding or coding denials management
Active, current, and unrestricted ARNP or PA license
Foreign trained medical graduate
RN, ARNP, PA, or foreign medical graduate, plus CCS
Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
Primary Location: Texas
Facility: 963-Santa Ana, CA
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.