medmix · 3 hours ago
Clinician, Denial Management - Remote
United States
Full-time
Remote
Mid Level
$85K/yr - $85K/yrmedmix is seeking a Clinician for Denial Management who will review appeals against medical records to ensure accuracy and thoroughness. The role involves maintaining the integrity of information in appeals, researching payer denials, and identifying opportunities for process improvement.
Health CareManufacturingMedicalMedical Device
Responsibilities
Maintain the integrity of information in each appeal produced
Review a high volume of written appeals to ensure information is medically accurate
Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment
Make recommendations for workflow revisions to improve efficiency and reduce denials
Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate
Identify opportunities for process improvement and actively participate in process improvement initiatives
Other duties as assigned
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Understand and comply with Information Security and HIPAA policies and procedures at all times
Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Qualification
Required
4-year degree in a related field is required
Must be a Registered Nurse with clinical experience
Experience in medical chart review
Hospital nursing experience
Ability to learn proprietary databases
Proficiency in Microsoft Office Suite
Strong interpersonal skills, ability to communicate well at all levels of the organization
Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
High level of integrity and dependability with a strong sense of urgency and results oriented
Excellent written and verbal communication skills required
Gracious and welcoming personality for customer service interaction
Company
medmix
Medmix produces and supplies medical equipment, including dental syringes, spreaders, and accessories for the healthcare sector.
Founded in 2006
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Girts Cimermans
Chief Executive Officer
Francisco Faoro
Chief Technology Officer
Recent News
2025-07-24
Company data provided by crunchbase