[Hiring] Clinical Denial Specialist @Franciscan Alliance, Inc.

Role Description

The Clinical Denial Specialist II functions as a hospital liaison to appeal denied claims for Medicare, Medicaid, Managed and Commercial insurance. This position entails detailed retrospective review via EPIC of patient medical records to analyze and compile data for additional documentation requests and claim denials, using trends and patterns identified to support process improvement.

• Schedule: Monday - Friday, 8am - 4:30 pm EST
• Develop reports.
• Review governmental contractor’s response.
• Identify underlying root causes for potential denials and work closely with departments and Clinical Documentation Integrity to reduce denials.
• Write and ensure all appeals are filed in a prompt and timely manner for Medicare, Medicaid, Managed, and Commercial Payors.
• Audit medical documentation for adherence to insurance and CMS guidelines relating to inpatient/observation services, or other denial issues.
• Use knowledge of inpatient criteria to establish medical necessity letters.

Qualifications

• Bachelor's degree in Nursing or Associate degree in Nursing with 5 years of nursing experience required
• Active Indiana RN license required
• 3 years of denial related experience required
• 5 years Nursing or Case Management preferred

Requirements

• TRAVEL IS REQUIRED: Never or Rarely
• JOB RANGE: Clinical Denials Specialist II: $67,142.40 – $92,331.20
• INCENTIVE: Not Applicable

Equal Opportunity Employer

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity.

Benefits

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.