Clinical Denials Specialist

United Audit Systems, Inc. (UASI), a rapidly growing healthcare consulting firm seeks to expand its professional team of employees by adding experienced Clinical Appeals Review Nurse to our team. The Clinical Appeals Review Nurse is responsible for completing clinical denial reviews to determine appropriate appeal of patient accounts. The ideal candidate will have a combination of clinical experience in a hospital acute care setting and experience providing reviews of the hospital billing and charging policies.

Primary Responsibilities:

• Completes clinical review of pre- and post-claim denials

• DRG Denials

• Perform a variety of audit services including charge audit, compliance audit, medical necessity, denials and other requests as needed. Audits may be performed on a concurrent or retrospective basis

• Review and analyze the client inpatient and/or outpatient itemized billing statement and the patient medical record and related documentation to identify items that were not billed correctly.

• Document findings on appropriate form and submit findings to client management staff daily so new billing forms can be generated in hospitals billing systems.

• Adhere to the National Health Care Billing Audit Guidelines, UASI Code of Conduct and Compliance Program, and the client third party audit policy while performing all duties.

• Attend meetings with members of client-hospital finance, medical records, and ancillary departments.

• Educate Client-Hospital personnel on validation and documentation of charges if requested by client contract relationship.

• Navigate hospitals medical record system and understand where to locate the financial information in relation to the patient payor billing information

Requirements:

• RN Certification

• CCDS or CDIS Certification preferred

• Experience with DRG Denials

• Epic experience preferred

• InterQual and Medical Necessity experience

• Ability to read and comprehend itemized billing statement, patient medical record and other laboratory reports

• Ability to analyze medical information and determine appropriate billing procedures

• Ability to effectively communicate with others

• Analytical thinking process

UASI is the employer of choice due to our outstanding reputation for excellence within the industry and for our comprehensive benefit package which includes:

• Medical, dental, vision and life insurance, short/long-term disability, 401(K) and referral bonuses

• Training opportunities and reimbursement for professional certifications

• UASI's unique approach to employee appreciation which include: birthday recognition, holiday gift selections, performance awards, and years of service awards