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UASI · 16 hours ago

Clinical Denials Specialist

United States

Full-time

Remote

Mid Level

United Audit Systems, Inc. (UASI) is a rapidly growing healthcare consulting firm seeking to expand its professional team by adding an experienced Clinical Appeals Review Nurse. The role involves completing clinical denial reviews to determine appropriate appeals of patient accounts, requiring a combination of clinical experience and knowledge of hospital billing policies.

Hospital & Health Care

Culture & Values

Responsibilities

Completes clinical review of pre- and post-claim denials

DRG Denials

Perform a variety of audit services including charge audit, compliance audit, medical necessity, denials and other requests as needed. Audits may be performed on a concurrent or retrospective basis

Review and analyze the client inpatient and/or outpatient itemized billing statement and the patient medical record and related documentation to identify items that were not billed correctly

Document findings on appropriate form and submit findings to client management staff daily so new billing forms can be generated in hospitals billing systems

Adhere to the National Health Care Billing Audit Guidelines, UASI Code of Conduct and Compliance Program, and the client third party audit policy while performing all duties

Attend meetings with members of client-hospital finance, medical records, and ancillary departments

Educate Client-Hospital personnel on validation and documentation of charges if requested by client contract relationship

Navigate hospitals medical record system and understand where to locate the financial information in relation to the patient payor billing information

Qualification

RN CertificationDRG DenialsCDDSCDIS CertificationEpic experienceInterQual experienceMedical Necessity experienceAnalytical thinkingEffective communication