Clinical Documentation Integrity Denials | Clinical Documentation Integrity | Full Time | Day Shift Position Available In Lake, Florida
Tallo's Job Summary: The Clinical Documentation Integrity Denials position is seeking a Registered Nurse with hospital clinical experience in clinical documentation, case management, and basic hospital reimbursement. Responsibilities include coordinating and performing medical necessity reviews, writing comprehensive medical necessity and clinical appeal letters, identifying root causes of denials, tracking hospital denials, and conducting chart audits. Qualifications include an Associate's degree, Florida Registered Nurse License, and 5 years of clinical experience. Preferred experience in clinical review & documentation, ICD10 & ICD9 coding, hospital case management, or insurance care management.
Job Description
Clinical Documentation Integrity Denials | Clinical Documentation Integrity | Full Time | Day Shift 3.8 3.8 out of 5 stars 600 East Dixie Avenue, Leesburg, FL 34748
Overview:
The Clinical Documentation Integrity Denials is a Registered Nurse with hospital clinical experience in clinical documentation, case management, and basic hospital reimbursement. Coordinates and performs medical necessity review of pre-bill AP C and denied services. Reviews, writes, and submits complete & comprehensive medical necessity and clinical appeal leers. Assists in the identification of root cause of denials. Tracks and trends hospital denials and explores corrective action. Performs chart audits to reconcile all detailed charges with clinical documentation. Conducts and oversees Recovery Audit, analyze, writes and tracks status of all activity from beginning to closure. Maintains communication with all involved in the process on timelines, status, resolution, and findings.
Qualifications:
Education Associate’s degree Required Bachelor’s Degree Preferred Licensure/Certification/Registration Florida Registered Nurse License
BLS ACLS
Special Skills/Qualifications/Additional Training/Experience Required Knowledge in clinical documentation and case management criteria.
Experience:
(5) years clinical experience required. Experience in clinical review & documentation, ICD10 & ICD9 coding, hospital case management, or insurance care management preferred. Knowledgeable of medical necessity definitions and documentation, insurance payer requirements, hospital charging, coding, billing, denials management, appeal submission, and account reconciliation. Understanding of HIPAA, Medical Billing Compliance Law, Medicare and other payer guidelines.
