Job Description

Clinical Appeals Specialist (Patient Accounting)

Additional Position Details: FTE: 1.000000 | Full Time | Primarily Mon - Fri / 8AM - 5PM

Starting Wage: $36.79-$50.59 per hour, depending on experience


Please note: This is a remote position. Candidates will be required to have reliable broadband internet and personal cell phone service. Remote work may include training and working during Pacific Standard business hours. Also, our remote work opportunities are limited to specific states, and remote work may not be supported in the state in which you reside.

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Position Summary

The

Clinical Appeals Specialist

is responsible for managing clinical denials by conducting a comprehensive review of clinical documentation and formulating a timely and defensible written response based on clinical documentation, evidence-based medical necessity criteria, physician documentation and medical policies of the payor. Communicates identified denial trends and patterns to the Manager of Patient Accounting, the Director of Revenue Cycle, and all applicable patient accounting leaders. Works to review, evaluate, and improve the enterprise clinical denial and appeal process. At the direction of the Manager of Patient Accounting, this individual will orchestrate education and other performance improvement initiatives to impact clinical quality, improve efficiency, and mitigate lost revenue related to medical necessity denials.


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Qualifications and Requirements

Experience

3 years of Clinical RN experience, including 1 year of Denial Management or Case Management or related experience, and 1 year of current experience with reimbursement methodologies Experience preparing appeals for clinical denials

Education

Bachelor's degree in Nursing, or Allied Health field, or equivalent is preferred*

Licensure/Certifications

RN: Registered Nurse licensed by the Oregon State Board of Nursing (OSBN) is requiredupon start CCM: Certified Case Manager is preferred*
CDDS: Certified Clinical Documentation Integrity Specialist (CCDS) by ACDIS is preferred*

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What We Offer

Competitive starting wage Comprehensive benefits including medical, dental, vision, and wellness Excellent retirement package with up to 6% employer contribution Generous Earned Time Off Tuition reimbursement after one year of service
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About Asante and Southern Oregon

Asante is a local, community-owned and governed, not-for-profit organization that provides comprehensive health care services to more than 550,000 people in a nine-county area of Southern Oregon and Northern California. It includes Asante Ashland Community Hospital in Ashland, Asante Rogue Regional Medical Center in Medford, Asante Three Rivers Medical Center in Grants Pass, Asante Physician Partners throughout the Rogue Valley, and additional health care partnerships. Virtually all medical specialties and services are represented within an organization dedicated to providing exceptional care. With over 5,000 employees, Asante's entities offer outstanding opportunities for career advancement and professional growth. At Asante, your work positively impacts your family, friends, neighbors, and the community. Experience the difference in how you work, how you live, and how you connect.


At Asante, we are defined by our values - traits that guide us as we serve patients and the community:

Excellence - Respect - Honesty - Service - Teamwork

Asante is an equal opportunity employer. We are committed to employ and advance in employment women, minorities, qualified individuals with disabilities and protected veterans.