<p>Overview</p> <p>Summary</p> <p>Reviews clinical information and supporting documentation for outpatient or Part B services to determine appeal action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned.</p> <p>Responsibilities</p> <p>Reviews, assesses, and evaluates all communications received in order to optimize reimbursement.</p> <p>Evaluates clinical information and supportive documentation prior to initial appeal action in order to optimize reimbursement and utilization of resources.</p> <p>Prepares response to appeal/request for information based on supporting clinical information in order to enhance reimbursement and maximize customer satisfaction.</p> <p>Compiles, analyzes, and distributes necessary clinical and financial information and presents reports to other healthcare providers in order to improve performances, and increase awareness of resources consumed related to reimbursement.</p> <p>Completes assigned goals.</p> <p>Requirements, Preferences and Experience</p> <p>Education</p> <p>Minimum: Ability to type and/or key accurately and have strong organizational skills.</p> <p>Experience</p> <p>Preferred: 3 years clinical experience and at least or 3 years payer experience.</p> <p>Minimum: 2-5 years clinical experience in a clinical care setting.</p> <p>Licensure, Registration, Certification</p> <p>Preferred: RHIT;LPN;RN</p> <p>Special Skills</p> <p>Minimum: Excellent communication skills. Advanced computer literacy skills with the ability to type and key accurately.</p> <p>Training</p> <p>Minimum: Requires critical thinking and judgement and must demostrates the ability to appropriately use standard criteria established by payers.</p>