You haven't searched anything yet.
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
The OP Clinical Denial Specialist supports the organization by reducing financial liability and recovering lost revenue for coding and medical necessity denials. This individual is responsible for, but not limited to: managing medical denials by conducting a comprehensive review of clinical documentation, writing compelling arguments based on the clinical documentation and the medical policies of the payor, submitting appeals in a timely manner, and identifying/resolving denial trends to mitigate potential loss. The OP Clinical Denial Specialist will also handle audit-related / compliance responsibilities and other administrative duties as required. This individual works closely with colleagues within the organization and with managed care payers to resolve issues and expedite reimbursement on overturned appeals.
EEO/AA/Disability/Veteran
EDUCATION
Two (2) years of college or equivalent with familiarity with medical terminology and anatomy. Knowledge of coding , billing and the revenue cycle. Working knowledge of human anatomy and physiology, Disease process , demonstrated knowledge of medical terminology and the medical record.
EXPERIENCE
Three to five years of coding and/or billing experience required. Previous experience with governmental and managed care denial/appeal process including familiarity with RAC. Experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, 1500). Epic HB billing knowledge preferred.
LICENSURE
Certified Coding Specialist (CCS), Certified Coding Specialist Physician based (CCS-P) certification through the American Health Information Management Association (AHIMA) and/or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) through American Academy of Professional Coders (AAPC) or similar certification is required, or must be obtained within a year of hire.
SPECIAL SKILLS
In-depth knowledge of documentation elements within the medical record. Expertise in governmental payment policies and regulations including medical necessity, NCCI, OCE, and MUE policies and procedures. Ability to analyze and resolve coding and medical necessity payer denials through in depth knowledge of payer policies and appeal procedures. Previous experience with clinical denials and appeals for all payers is preferred.
Per Diem
$66k-85k (estimate)
05/07/2024
05/20/2024
ynhhs.org
MYSTIC, CT
50 - 100
1996
$5M - $10M
Ancillary Healthcare
Yale New Haven Health is making it easier for people to access the latest medical treatments, advanced research and innovations through our five outstanding hospitals Yale New Haven, Bridgeport, Greenwich, Lawrence + Memorial and Westerly and our affiliation with the prestigious Yale University and its highly-ranked Yale School of Medicine. Plus, our patients benefit from access to hundreds of dedicated primary care physicians and specialists in Northeast Medical Group and Yale Medicine. We also have advanced clinical relationships with multiple hospitals and numerous outpatient locations th...roughout the state so you can get the care you need, when you need it. As one organization, were working together to make health care more patient-focused, more accessible and more cost-effective. Some call it personalized medicine. We call it good care. For more information, check out the YNHHS Web site: www.ynhhs.org
More
Show less