Senior Commercial Analyst
Labcorp
Tableau
Clinical Government Audit Analyst, Appeal Specialist II
Stanford Health Care
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $63 - $83 per hour
Job Level
JuniorMid-Level
About the role
- Conduct thorough analyses of denials, evaluating the appropriateness of medical services and procedures.
- Maintain accurate records of appeals and denials for tracking and reporting purposes.
- Independently compose professional and comprehensive appeal letters to payors after a detailed review of medical records.
- Create comprehensive appeal strategies based on relevant guidelines and documentation to effectively address denials.
- Draft and submit detailed appeal letters along with supporting documentation, ensuring adherence to regulatory requirements and payor guidelines.
- Provide a thoughtful appealability score for each denial under review, assessing the likelihood of a successful appeal.
Requirements
- Bachelor’s degree in a work-related discipline/field from an accredited college or university
- Minimum two (2) years of progressive denials and appeals experience.
- Knowledge of medical and insurance terminology, MS-DRG, APR-DRG, CPT, ICD coding structures, and billing forms (UB, 1500).
- Proficiency in computer systems, specifically EPIC and 3M.
- Proficiency in computer software, including Microsoft Word, Excel, and Power Point.
- CCA - Certified Coding Assoc required within 180 Days or CCS - Certified Coding Specialist required within 180 Days or Certified Outpatient Coder - COC required within 180 Days or CDIP – Clinical Documentation Improvement Practitioner required within 180 Days or CCDS - Cert Clinical Document Spec required within 180 Days or RN - Registered Nurse - State Licensure And/Or Compact State Licensure required.
Benefits
- Health insurance
- 401(k)
- Flexible work hours
- Paid time off
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical services analysisappeals processappeal letter compositionappeal strategiesregulatory complianceappealability scoringmedical codingbilling formsCPT codingICD coding
Soft skills
attention to detailindependent workprofessional communicationanalytical thinkingproblem-solving
Certifications
Certified Coding Associate (CCA)Certified Coding Specialist (CCS)Certified Outpatient Coder (COC)Clinical Documentation Improvement Practitioner (CDIP)Certified Clinical Document Specialist (CCDS)Registered Nurse (RN) State Licensure
