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Responsibilities
Primary duties may include but are not limited to responsibility for reviewing assigned clinically related denials payer audits and payer correspondence as well as preparation of relevant appeal submission or audit responses.

Utilizes clinical expertise and critical thinking in the evaluation of medical records against appropriate criteria and contract requirements and utilizes appropriate communication style to appeal or defend medically denied claims.

Is a liaison and resource to revenue cycle clinical practice stakeholders in defending clinically denied claims and providing relevant feedback to key stakeholders on denial prevention opportunities.

Qualifications
High School Diploma/GED and a minimum 3 years of relevant clinical experience required

Experience in denials and appeals revenue cycle audits or prior authorization preferred.

Knowledge and use of payer medical policy and Medicare LCD/NCD criteria.

Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements.

Knowledge of billing and coding requirements. Knowledge and experience in Epic.