<p>Overview The Clinical Documentation Integrity Denials is a Registered Nurse with hospital clinical experience in clinical documentation, case management, and basic hospital reimbursement. Coordinates and performs medical necessity review of pre-bill AP C and denied services. Reviews, writes, and submits complete & comprehensive medical necessity and clinical appeal leers. Assists in the identification of root cause of denials. Tracks and trends hospital denials and explores corrective action. Performs chart audits to reconcile all detailed charges with clinical documentation. Conducts and oversees Recovery Audit, analyze, writes and tracks status of all activity from beginning to closure. Maintains communication with all involved in the process on timelines, status, resolution, and findings. Qualifications Education Associate's degree Required Bachelor's Degree Preferred Licensure/Certification/Registration Florida Registered Nurse License BLS ACLS Special Skills/Qualifications/Additional Training/Experience Required Knowledge in clinical documentation and case management criteria. Experience: (5) years clinical experience required. Experience in clinical review & documentation, ICD10 & ICD9 coding, hospital case management, or insurance care management preferred. Knowledgeable of medical necessity definitions and documentation, insurance payer requirements, hospital charging, coding, billing, denials management, appeal submission, and account reconciliation. Understanding of HIPAA, Medical Billing Compliance Law, Medicare and other payer guidelines.</p>