Clinical Appeals Specialist II (REMOTE)

The Appeals Specialist II, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for report trending. This position provides SSC and ancillary departments all payor updates regarding billing and coding updates/changes, completes timely and consistently reports project status SSC leadership and maintains confidentiality of data and information. This position provides feedback to facilities regarding denials that are resulting in retractions.

Responsible for review and resolution of pre pay insurance denials, correlating with the follow-up teams. Works closely with Denial Coordinator, Facility Denial Liaison, and Managed Care Coordinator for education and payer accountability. Consults with managers and staff on developmental needs for new processes and makes recommendation to change. Maintains knowledge of practice management systems, basic coding and billing knowledge, customer service techniques, basic insurance/carrier knowledge, and front office operation policies. Gathers and makes available appropriate educational resources (e.g. books, video tapes/audio Works with associates, departments and facilities to understand denial/appeal management processes. Performs other duties as assigned. Complies with all policies and standards.