[Hiring] Clinical Appeal Specialist @Moffitt Cancer Center

Role Description

Responsible for the administration and coordination of the denials review and appeals management processes that includes:

• Denials management
• Claims recovery
• Denial root cause analysis

Qualifications

• Associate's Degree in Healthcare, Finance, or other related field
• Bachelor's Degree plus a minimum of five (5) years healthcare experience and RN required (OR)
• "In lieu of" a Bachelor's degree, an Associate's degree plus seven (7) years healthcare experience preferably in Nursing
• RN license required
• Accommodation: LPN's currently in the role of Clinical Denial Specialist will be given a specified time frame (2 years) to obtain the RN licensure

Requirements

• Computer literate, knowledge of financial data analysis, Medicare and Medicaid regulations, third party reimbursement, and charging and coding guidelines
• Intermediate Excel skills
• Excellent communication skills both written and verbal
• Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules)
• Knowledge of managed care industry including payer structures, administrative rules, and government payers
• Adept in hospital and insurance reimbursement and billing concepts and procedures, as well as laws and regulations affecting payment compliance, denials and appeals recovery
• Proficiency with various reimbursement methodologies including, but not limited to, Per-Diem, DRG, fee schedule, percentage of charges, and stop loss
• Proficient understanding of medical coding systems affecting the adjudication of claims payment (ICD-9, CPT, HCPCS, DRG, APG, APC, and revenue code structures)
• Proficiently utilizes MS Office applications, including MS Excel and MS Access

Soft Skills

• Ability to work collaboratively in a team environment or independently, as applicable
• Must be able to anticipate obstacles to a goal and initiate appropriate resolution
• Must have initiative to identify barriers and opportunities and provide solutions through process and operational improvements
• Requires investigation and analytical skills with a proven ability to communicate effectively in both written and verbal format
• Able to communicate (both written and verbal) professionally and effectively
• Requires exceptional attention to detail and demonstrated ability to prioritize work to ensure accuracy and timely completion

Preferred

• Experience in oncology nursing, utilization review, quality management, and/or recent case management
• Soarian experience

Salary Range

$31.99 - $48.80

Salary ranges posted for this position represent the expected base pay range for the role. Actual compensation may vary based on location and a variety of job-related factors, including experience, skills, education, and internal equity among Team Members in similar positions.

Company Description

Moffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or protected veteran or disabled status. We seek candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence.