Clinical Government Audit Analyst & Appeal Specialist II - Remote

Overview

The Clinical Government Audit Analyst and Appeal Specialist II plays a critical role in managing and resolving clinical appeals related to government audits and denials, contributing to the financial health of the organization.

In Short

• Manage clinical appeals related to government audits and denials.
• Conduct denial analysis and ensure accurate coding.
• Compose professional appeal letters to payors.
• Create comprehensive appeal strategies based on guidelines.
• Maintain records of appeals and denials for tracking purposes.
• Collaborate with clinical staff and coding professionals.
• Stay updated on healthcare regulations and policies.
• Participate in developing appeal templates and audit tools.
• Ensure compliance with Medicare and Medicaid guidelines.
• Complete tasks by established deadlines.

Requirements

• Bachelor’s degree in a related field.
• Minimum two years of experience in denials and appeals.
• Strong analytical and communication skills.
• Knowledge of medical and insurance terminology.
• Experience with coding and clinical validation.
• Proficiency in healthcare compliance and billing practices.
• Ability to manage multiple tasks and meet deadlines.
• Proficient in Microsoft Word, Excel, and PowerPoint.
• Licenses and certifications required within 180 days.
• Ability to maintain confidentiality of sensitive information.

Benefits

• Competitive salary range.
• Work in a supportive and innovative environment.
• Opportunities for professional development.
• Engagement in meaningful work impacting patient care.
• Collaborative team atmosphere.
• Commitment to diversity and equal opportunity.
• Access to healthcare benefits.
• Flexible work arrangements.
• Employee wellness programs.
• Ongoing training and education opportunities.