Conduct thorough and accurate reviews of insurance denials and appeals
Advocate for patients and healthcare providers by communicating and negotiating with insurance companies
Utilize clinical knowledge and expertise to identify and resolve issues with clinical denials and appeals
Collaborate with other members of your team to gather necessary information and documentation for appeal
Ensure timely and accurate submission of clinical appeals
Maintain detailed and organized documentation of denials and appeals processes
Stay up-to-date on insurance policies and regulations to ensure compliance in appeals
Communicate effectively with patients, healthcare providers, and insurance companies regarding denials and appeals
Monitor and track the success rate of appeals and identify areas for improvement
Adhere to ethical and legal standards in all aspects of the job
Maintain confidentiality of patient information and adhere to HIPAA regulations
Participate in meetings and committees related to denials and appeals
Continuously seek opportunities to improve processes and efficiency
Ensure timely and accurate reporting of denials and appeals to management
Bachelor’s degree in Nursing, Health Administration, or a related field. Advanced clinical degrees preferred (e.g., RN, NP, PA)
Minimum of 2 years of clinical experience in a healthcare setting
Experience in clinical appeals, pre-authorizations, utilization review, or case management is highly desirable
TRC Talent Solutions is proud to be an Equal Opportunity Employer (EOE). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. At TRC, we take pride in fulfilling our opportunity to add value to our client's business as their staffing partner, while working tirelessly to connect thousands of individuals each year with work opportunities where they can meet the needs of their families and have the potential to build their careers.
| Location | Washington, DISTRICT OF COLUMBIA |
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