Clinical Denial Specialist II
Franciscan Alliance, Inc.The Clinical Denial Specialist II functions as a hospital liaison to appeal denied claims for Medicare, Medicaid, Managed and Commercial insurance. This position entails detailed retrospective review via EPIC of patient medical records to analyze and compile data for additional documentation request and claim denials, using trends and patterns identified to support process improvement.
WHO WE ARE
With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.
WHAT YOU CAN EXPECT
Schedule: Monday – Friday, 8am - 5pm
Develop reports
Review governmental contractor’s response
Identify underlying root causes for potential denials and works closely with departments and Clinical Documentation Integrity to reduce denials
Write and ensure all appeals are filed in a prompt and timely manner for Medicare, Medicaid, Managed, and Commercials Payor
Audit medical documentation for adherence to insurance and CMS guidelines relating to inpatient/observation services, or other denial issues
Knowledge of inpatient criteria to establish medical necessity letters
QUALIFICATIONS
Active Indiana RN license required
BSN or Associate's with 5 years of nursing experience required
3 years of denial experience required
5 years of nursing or case management experience preferred
TRAVEL IS REQUIRED:
EQUAL OPPORTUNITY EMPLOYER
It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.
Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.
Franciscan Alliance is committed to equal employment opportunity.
Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.