Clinical Appeals Specialist

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 working day-to-day operations during Pacific Standard business hours or online training. Candidates must live within the United States, and due to our pay practices, we are not able to employ candidates living in some states.

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.

Position Qualifications

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 is required
• Experience preparing appeals for clinical denials- preferred.

Education

• Bachelor's degree in Nursing or allied health field or equivalent- preferred

Certification/Licensure

• Registered Nurse Licensed by the Oregon State Board of Nursing is required
• Certified Clinical Documentation Integrity Specialist (CCDS) by ACDIS- preferred
• CCM: Certified Case Manager- preferred

Total Rewards

We offer a comprehensive Total Rewards package designed to support your well-being and professional growth, including:

• Competitive Pay: Hourly and salaried positions earn market-based compensation.
• Health & Wellness: Medical, dental, and vision coverage for part-time and above employees and their eligible dependents beginning within 30 days of hire.
• Retirement Savings: Employer-sponsored retirement plan with company contribution and match.
• Paid Time Off: Generous ETO for part-time and above employees.
• Professional Development: Continue to enhance your education through our tuition reimbursement and tuition repayment program
• Additional Benefits: Life insurance, disability coverage, and employee assistance programs.

At Asante, we are guided by our values:

Excellence - Respect - Honesty - Service - Teamwork

Asante is proud to be an Equal Opportunity Employer. We are committed to creating a diverse and inclusive workplace and to employing and advancing qualified individuals of all backgrounds, including women, minorities, individuals with disabilities, and protected veterans.