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Appeals and Denials Specialist Accuity Job Type
Full-time
Description
The Appeals and Denials Specialist is responsible for triaging and writing DRG downgrades and clinical validation appeal letters for multiple clients. The Appeals and Denials Specialist will ensure appropriate action is taken within appeal deadlines. This position collaborates with the Appeals and Denials team and other departments as needed.
PRIMARY JOB RESPONSIBILITIES:
Performs review of the medical record including documentation, reports, flowsheets, and test results, applying evidence-based criteria related to DRG and clinical validation denials Creates appeal letters utilizing the relevant information from the medical record; supported by current clinical standards and facility guidelines, evidence-based medicine, professionally recognized standards of health care, and ICD-10-CM/PCS Official Coding Guidelines Is flexible, able to navigate multiple EHRs and other databases used by Accuity or the client, performs reviews, and submits letters of appeal per the client specific workflows Able to prioritize cases to meet appeal deadlines Detail-oriented Collaborates with Accuity Physician and Accuity CDI in appropriately identified clinical denials requiring communication to the Accuity clinical review teams Maintains clinical expertise and trends in healthcare, reimbursement methodologies and specialty areas by participating in professional organizations, seminars, and educational programs Performs miscellaneous job-related duties as assigned
Requirements
POSITION QUALIFICATIONS:
Education:
Associate or bachelor's degree in nursing or licensure in other clinical healthcare field such as MD, NP, PA. Experience:
Minimum 3 years of CDI experience or experience with clinical inpatient DRG Downgrades and clinical denials Licensure and/or Credentials:
At least one of the following: MD, RN, BSN, CCDS, CDIP Knowledge, Skills, and Abilities:
Inpatient clinical experience Extensive knowledge of revenue cycle management and coding services Requires good interpersonal and customer service skills Demonstrated knowledge of ICD-10-CM, ICD-10-PCS Motivated and self-directed Experience with electronic health records and health information systems Organized and able to prioritize to ensure objectives are met in a timely manner Ability to establish and maintain cooperative working relationships with physicians and staff Ability to use a PC in a Windows environment, including MS Word, Excel and PPT Independent, focused individual able to work remotely Phoenix, AZ, US, 85003Posted 2 days ago Controller - Mesa, Gilbert, Chandler, Tempe (East Valley) Vaco By submitting to this position, you agree that you will be giving Vaco the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal. Phoenix, AZ, US, 85003Posted 2 days ago Part Time B2b Collector. Vaco As a Business-to-Business Collections Specialist, you will be responsible for managing and overseeing the collection of outstanding accounts receivable balances from business clients. You will utilize effective communication and negotiation skills to ensure timely payments while maintaining positive relationships with clients. This role requires a keen attention to detail, strong organizational skills, and the ability to work collaboratively with internal teams to resolve payment issues. Scottsdale, AZ, US, 85261Posted 2 days ago Financial Readiness Manager.Wounded Warrior Project The Wounded Warrior Project (WWP) Financial Readiness (FR) Manager leads their Financial Readiness team while establishing best practices, streamlining departmental workflow, and promoting continuous improvement. The manager supervises and acts as a case manager for wounded Post 9/11 veterans, service members, and their families providing one-on-one assessments of their financial needs. In this capacity the manager assesses needs within services guidelines, provides connections to resources, and guidance for the warriors to make better informed decisions regarding their individual financial situation. The Financial Readiness Manager is responsible for team training programs & coaching the FR team to provide emergent financial assistance grants for warrior households in financial crisis. Phoenix, AZ, US, 85003Posted 2 days ago Financial Analyst Consultant - Phoenix.Vaco We are seeking a dynamic and experienced professional to join our team as an FP&A (Financial Planning & Analysis) Consultant! As an FP&A Consultant, you will collaborate with clients to deliver comprehensive financial planning and analysis services. This is an exciting opportunity for a strategic financial professional to contribute to our clients' success through insightful analysis, forecasting, and financial planning. The ideal candidate will have a strong analytical mindset, excellent communication skills, and a proven track record in financial modeling and strategic planning. Phoenix, AZ, US, 85003Posted 2 days ago Interim Non - Profit Accountant. Vaco By submitting to this position, you agree that you will be giving Vaco the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal. Phoenix, AZ, US, 85003Posted 2 days ago Fractional Finance Consultant. Vaco Vaco has partnered with a local aircraftcompany searching for a Fractional Finance Consultant. This is a temporary position that requires a seasoned professional with a strong background in finance and accounting. If you are ready to make an immediate impact, please apply today! Phoenix, AZ, US, 85003Posted 2 days ago Accounting Lead/Manager - Mesa, Gilbert, Chandler, Tempe (East Valley)Vaco We are seeking an experienced and skilled professional to join our team as a Consultant Accounting Lead! As a Consultant Accounting Lead, you will play a key role in ensuring the accuracy, efficiency, and compliance of financial operations. You will be responsible for overseeing the day-to-day accounting functions, leading a team of skilled professionals, and contributing to the strategic financial goals of the organization. The ideal candidate will have a strong background in accounting, excellent leadership skills and a passion for driving financial excellence. Phoenix, AZ, US, 85003Posted 2 days ago AP Lead. Vaco By submitting to this position, you agree that you will be giving Vaco the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal. Phoenix, AZ, US, 85003Posted 2 days ago Accounts Payable Analyst.Vaco Vaco has partnered with a fast growing organization in Chandler in their search for an Accounts Payable Analyst with prior knowledge of SAP and strong Excel Skills (VLookups, Pivot Tables, etc.) This candidate will have good troubleshooting abilities as it will handle a manual system initially while the accounting team implements a new automated system department wide. Chandler, AZ, US, 85249Posted 2 days ago Description
Job Type
Full-time
Description
The Appeals and Denials Specialist is responsible for triaging and writing DRG downgrades and clinical validation appeal letters for multiple clients. The Appeals and Denials Specialist will ensure appropriate action is taken within appeal deadlines. This position collaborates with the Appeals and Denials team and other departments as needed.
PRIMARY JOB RESPONSIBILITIES:
Performs review of the medical record including documentation, reports, flowsheets, and test results, applying evidence-based criteria related to DRG and clinical validation denials Creates appeal letters utilizing the relevant information from the medical record; supported by current clinical standards and facility guidelines, evidence-based medicine, professionally recognized standards of health care, and ICD-10-CM/PCS Official Coding Guidelines Is flexible, able to navigate multiple EHRs and other databases used by Accuity or the client, performs reviews, and submits letters of appeal per the client specific workflows Able to prioritize cases to meet appeal deadlines Detail-oriented Collaborates with Accuity Physician and Accuity CDI in appropriately identified clinical denials requiring communication to the Accuity clinical review teams Maintains clinical expertise and trends in healthcare, reimbursement methodologies and specialty areas by participating in professional organizations, seminars, and educational programs Performs miscellaneous job-related duties as assigned
Requirements
POSITION QUALIFICATIONS:
Education:
Associate or bachelor's degree in nursing or licensure in other clinical healthcare field such as MD, NP, PA. Experience:
Minimum 3 years of CDI experience or experience with clinical inpatient DRG Downgrades and clinical denials Licensure and/or Credentials:
At least one of the following: MD, RN, BSN, CCDS, CDIP Knowledge, Skills, and Abilities:
Inpatient clinical experience Extensive knowledge of revenue cycle management and coding services Requires good interpersonal and customer service skills Demonstrated knowledge of ICD-10-CM, ICD-10-PCS Motivated and self-directed Experience with electronic health records and health information systems Organized and able to prioritize to ensure objectives are met in a timely manner Ability to establish and maintain cooperative working relationships with physicians and staff Ability to use a PC in a Windows environment, including MS Word, Excel and PPT Independent, focused individual able to work remotely View more..