Senior Clinical Appeals Analyst – Telecommute

Job Brief

We have a vacancy of Senior Clinical Appeals Analyst – Telecommute in our company, Explore Job Search. This vacancy is based in Los Angeles CA. Please go through the job detail mentioned below.

Position Title: Senior Clinical Appeals Analyst – Telecommute
Company: Explore Job Search
Work Type: Full Time
City of work: Los Angeles CA
Salary:
URL Expiry: 2022-09-30
Posted on: jobsintelecom.net

Job Detail

To apply please visit:

https://jobs.explorejobsearch.com/job-detail/361926/senior-clinical-appeals-analyst-telecommute

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm)

Sr. Clinical Appeals Analyst will perform medical necessity reviews for Clinical Appeals Unit (CAU). This position will work collaboratively with the Patient Financial Services (PFS), Denials Management, CDI, and client to coordinate case flow, and to provide guidance regarding denial management. Sr. Clinical Appeals Analyst will be triaging denials routed to CAU to identify root-causes and directing cases to appropriate teams or personnel. This position will also be conducting thorough reviews of the medical records and drafting Provider appeal letters, preparing summaries for Administrative Law Judge or State Fair Hearings, as well as, discussing clinical denial root cause trends with client. This position will support Optum’s increased focus on streamlining outpatient and inpatient client clinical appeals. This position will enable CAU to bridge the gaps between Patient Registration/Authorization, Care Coordination, CDI / coding, denial management, and PFS teams. This role will also serve as navigator for the process flow, as well as, taking a lead in identifying opportunities in improving outcomes.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Responsible for triaging denials (Medical necessity vs. Coding vs. Technical) and identifying the denial root cause

Responsible for conducting reviews and responding to insurance denials. Writes concise, factual letters and provides medical record documentation to support appeal. Effectively communicates verbally with external and internal customers to ensure argument for appeal is clearly presented. Responsible for the denials process, including subsequent appeal to health insurance

Assures appropriate action is taken within appeal time frames to address denials received by CAU

Collaborates with other departments/resources/entities as applicable to ensure the most optimal appeal outcome

Utilizes appropriate applications (MIDAS +, Veracity, Artiva, eFR, Soarian EDM) to accurately track clinical denial data; participates in the development and implementation of a system-wide process for appeals

Experience in using hospital applications including but not limited to EMR (Cerner, Meditech, etc.)

Has extensive knowledge of applicable Medicare, Medicaid, or Commercial determinations and policies, including Local Coverage Determinations (LCD/LCA), National Coverage Determinations (NCD), Policy Bulletins, etc.

Ability to accurately apply utilization review criteria (InterQual and MCG) when necessary

Assists with continuous quality improvement of the established appeals process

Works in conjunction with multiple units in relation to front, middle, and back Revenue Cycle departments (i.e., Patient Registration / Authorization, Care Coordination, Coding, HIM, Patient Financial Services)

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Current, unrestricted RN license for RN applicants, or other clinical education such as medical school graduate, physician assistant, nurse practitioner (MD, DO, MBBS, PA, NP)

3+ years of solid clinical experience and strong knowledge of medicine and pathophysiology with understanding of clinical criteria and treatment of medical diagnoses

3+ years of experience with Electronic Health Records (Cerner, EPIC, or similar)

Experience in both inpatient and outpatient hospital settings

Proficient in Windows PC use, Microsoft Office 365 suite applications (Word, Excel, PowerPoint)

Preferred Qualifications:

Certification in Clinical Documentation Improvement (CCDS or CDIP)

Experience in InterQual and Milliman Care Guidelines (MCG) acute care guidelines

Experience in handling / writing provider appeals

Experience with principal and basic charging, medical billing, and reimbursement

Utilization Management or Case Management experience

Outpatient/inpatient coding reviews OR CDI experience OR having a coding certification from AAPC / AHIMA

Project management experience

Solid verbal communication and organization skills

Excellent written communication skills with the ability to clearly articulate ideas and arguments in a letter

Clinical discernment/critical thinking skill to identify what defines the patient encounter

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut/Nevada residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

To apply please visit:

https://jobs.explorejobsearch.com/job-detail/361926/senior-clinical-appeals-analyst-telecommute