Clinical Documentation Specialist, Remote
Trinity Health
Denials Prevention Specialist
Datavant
part-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $32 - $45 per hour
Job Level
Mid-LevelSenior
About the role
- Monitor and manage denials throughout the entire revenue cycle, including registration, eligibility, coding, billing, and medical necessity.
- Analyze denial trends and root causes using data analytics tools and electronic health record (EHR) systems.
- Collaborate with internal departments (HIM, billing, case management, patient access) to investigate and resolve complex denials.
- Utilize in-depth computer skills to navigate and extract data from multiple systems such as Epic, Cerner, Meditech, 3M, Optum, SSI, Availity, and payer portals.
- Submit and track appeals with payers, ensuring all documentation and deadlines are met.
- Prepare and present regular reports on denial metrics, recovery efforts, and opportunities for improvement.
- Stay current on payer policy changes, CMS updates, and healthcare regulations affecting claim adjudication.
- Serve as a key liaison between coding, billing, utilization review, case management, and payer relations to reduce denials and improve revenue leakage.
Requirements
- Associate's or Bachelor's degree in Health Information Management, Health Administration, or related field required.
- RHIT, RHIA, CCS, or CPC certification preferred.
- Minimum 3–5 years of experience in healthcare revenue cycle with focus on denials management.
- Strong knowledge of the entire revenue cycle including registration, coding, billing, and collections.
- Proficient in Microsoft Office Suite (especially Excel), EHRs, claims editing software, and data analytics tools.
- Exceptional analytical, organizational, and communication skills.
- Ability to interpret Explanation of Benefits (EOBs), Remittance Advice (RA), and payer policies.
- Demonstrated ability to work independently and within a team in a fast-paced environment.
- This job is not eligible for employment sponsorship.
- May require post-offer health screenings and proof and/or completion of vaccinations such as the flu shot, Tdap, COVID-19.
