What are the responsibilities and job description for the Appeals Specialist position at Springhill Medical Center?
Pre-Employment Requirements:
- We are a drug free facility. Passing a pre-employment drug screening is required .
Education/Experience Requirements:
- Current RN License, BSN preferred.
- Minimum of 2 years of experience with clinical validation denials, DRG downgrade denials, and appeal writing.
- Strong understanding of ICD-10 coding guidelines and clinical documentation standards.
- Knowledge of payer audit processes, RACs, commercial payer reviews, and denial rationale interpretation.
- Excellent written communication and clinical documentation analysis skills.
- Strong critical thinking and attention to detail.
- Proficiency with electronic medical records and Microsoft Office applications.
Qualifications
Licenses & Certifications
Required