Clinical Appeals Analyst at Revecore
United States
<div> <p><span><span>Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities.<span> </span></span><span>We're</span><span><span> </span>powered by people, driven by technology, and dedicated to our clients and employees. If<span> </span></span><span>you're</span><span><span> </span>looking for a collaborative and diverse culture with<span> </span></span><span>a great work</span><span>/life balance, look no further. </span></span><span> </span></p> <p><span><span> </span></span><span> </span></p> <p><strong><span><span>Revecore Perks:</span></span></strong><span><span> </span></span><span> </span></p> <ul> <li><span><span>We offer paid training and incentive<span> </span></span><span>plans</span></span><span> </span></li> <li><span><span>Our medical, dental, vision, and life insurance benefits are available from the first day of<span> </span></span><span>employment</span><span> </span></span><span> </span></li> <li><span><span>We enjoy excellent work/life<span> </span></span><span>balance</span><span> </span></span><span> </span></li> <li><span><span>Our Employee Resource Groups build community and foster a culture of belonging and<span> </span></span><span>inclusion</span><span> </span></span><span> </span></li> <li><span><span>We match 401(k)<span> </span></span><span>contributions</span><span> </span></span><span> </span></li> <li><span><span>We offer career growth<span> </span></span><span>opportunities</span><span> </span></span><span> </span></li> <li><span><span>We celebrate 12 paid holidays and generous paid time<span> </span></span><span>off</span><span><span> </span> </span></span><span> </span></li> </ul> <p><strong><span><span>Location: Remote -- USA</span></span></strong><span><span> </span></span><span> </span></p> <p><span><span> </span></span><span> </span></p> <p><strong><span><span>The Role:</span><span><span> </span></span><span>Clinical Appeals Analyst</span></span></strong><span> </span></p> <p> </p> <p><span><span>Primarily responsible for thorough review of claim denials from managed care and other insurance carriers and denial management activities related to the collection of denied hospital claims.<span> </span></span></span><span><span>Handle verbal and/or written appeals requiring clinical input or interpretation, as well as identify coding or clinical documentation issues and work to correct and overturn denials.</span></span><span> </span></p> <p> </p> <p><strong><span><span>As a<span> </span></span><span>Clinical Appeals</span><span><span> </span>Analyst, you will:</span></span></strong><span> </span></p> <ul> <li><span><span>Review and perform retrospective reviews, investigates and appeals all clinical level denials such as not medically necessary inpatient stays or levels of care,<span> </span></span><span>authorization</span><span><span> </span>or other denial<span> </span></span><span>issues</span></span><span> </span></li> <li><span><span>Audit Medical Records to retrieve clinical information for appeal, prepare appeal<span> </span></span><span>correspondence</span></span><span> </span></li> <li><span><span>Utilize online payor<span> </span></span><span>portals</span></span><span> </span></li> <li><span><span>Review and process correspondence including approvals and denials/adjustments, demand<span> </span></span><span>letters</span><span><span> </span>and results from various levels of<span> </span></span><span>appeals</span></span><span> </span></li> <li><span><span>Working with team to<span> </span></span><span>monitor</span><span>, track,<span> </span></span><span>trend</span><span><span> </span>and coordinate denial resolution with<span> </span></span><span>payers</span></span><span> </span></li> <li><span><span>Communicates with all parties in a professional manner to alert of specific problem<span> </span></span><span>issues</span></span><span> </span></li> <li><span><span>Performs other duties as<span> </span></span><span>assigned</span><span> </span></span><span> </span></li> </ul> <p><span><span> </span></span><span> </span></p> <p><strong><span><span>You will be successful if you have:</span></span></strong><span> </span></p> <ul> <li><span><span>Working knowledge of Microsoft Office suite (Word, Excel)</span></span><span> </span></li> <li><span><span>Moderate computer<span> </span></span><span>proficiency</span></span><span> </span></li> <li><span><span>Working knowledge of the revenue cycle</span></span><span> </span></li> <li><span><span>Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions,<span> </span></span><span>policies</span><span><span> </span>and procedures in written (in English) and diagram<span> </span></span><span>form</span></span><span> </span></li> <li><span><span>Ability to write routine correspondence (in English)</span></span><span> </span></li> <li><span><span>Ability to define problems, collect data,<span> </span></span><span>establish</span><span><span> </span></span><span>facts</span><span><span> </span>and draw valid<span> </span></span><span>conclusions</span></span><span> </span></li> <li><span><span>Strong customer service orientation</span></span><span> </span></li> <li><span><span>Excellent interpersonal and communication skills</span></span><span> </span></li> <li><span><span>Commitment to company values </span></span><span> </span></li> </ul> <p><strong><span><span>Education and Experience Requirements:</span></span></strong><span> </span></p> <ul> <li><span><span>Licensed as an RN or LPN (must<span> </span></span><span>possess</span><span><span> </span>and maintain a current state nursing license)</span></span><span> </span></li> <li><span><span>At least 3 years of experience as a Case Manager or equivalent is<span> </span></span><span>desired</span></span><span> </span></li> <li><span><span>At least 1 year experience with medical necessity appeals at all levels is<span> </span></span><span>preferred</span></span><span> </span></li> <li><span><span>Bachelor's degree desirable, but equivalent job experience will be<span> </span></span><span>considered</span></span><span> </span></li> <li><span><span>Experience using standardized clinical guidelines; InterQual experience<span> </span></span><span>preferred</span></span><span> </span></li> </ul> <p><strong><span><span>Work at Home Requirements:</span></span></strong><span> </span></p> <ul> <li><span><span>A quiet, distraction-free environment to work<span> </span></span><span>from in</span><span><span> </span>your home. </span></span><span> </span></li> <li><span><span>A reliable hard-wired private internet connection that is not supplied via cellular data or hotspot is<span> </span></span><span>required</span><span>. </span></span><span> </span></li> <li><span><span>Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. </span></span><span> </span></li> <li><span><span>The workspace area accommodates all workstation equipment, related materials, and provides adequate surface area to be productive. </span></span><span> </span></li> </ul> <p><span><span>Revecore is an equal opportunity employer that does not discriminate<span> </span></span><span>on the basis of</span><span><span> </span>race, color, religion, sex or gender, gender identity or expression, sexual orientation, national origin, age, disability status, veteran status, genetic information, or any other legally protected status. </span></span><span> </span></p> <p><span><span> </span></span><span> </span></p> <p><span><span>We believe that a diverse workforce fosters innovation and creativity, enriches our culture, and enables us to better serve the needs of our clients and communities. We welcome and encourage individuals of all backgrounds, perspectives, and abilities to apply. </span></span><span> </span></p> <p> </p> <p><span><span>Must </span><span>reside</span><span><span> </span>in the United States within one of the states listed below: </span></span><span> </span></p> <p><span><span>Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota (CST Time Zone), Tennessee, Texas (CST Time Zone), Vermont, Virginia, Wisconsin, and West Virginia. </span></span><span> </span></p> </div>
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