Revenue Cycle Medical Billing Appeal Resource Utilization Clinical Writer - Located in West Plains, MO

About the Role

The Clinical Appeal Writer audits medical necessity justification for air transport evaluation and submission of all medical necessity appeals for government payors. They utilize clinical flight experience, established clinical standards and protocols, to validate air medical necessity and appeal payment denials.

Essential Functions

• Conducts audits of the medical necessity appeals for all payor sources in the role of advocate for the patient and GMR.
• Ensures appeal timelines are met by moving the assigned book of business through the appeals process and updates appeals database.
• Works with fixed deadlines and demonstrates willingness to meet and exceed performance metrics.
• Works with the Appeal team to determine the best approach to each clinical denial in order to maximize claim reimbursement and minimize the financial risk to patients and GMR.
• Maintains strict confidentiality of all protected health information and cooperates fully with all information security guidelines related to the scope of work.

Qualifications

• Minimum of five years in Emergency department (ED), Intensive Care Unit (ICU), flight or ambulance experience or job experience equivalent.
• Supervisory/leadership experience preferred (i.e.: team leader, FTO, charge nurse, preceptor, educator, etc.).
• Proficient in Word, Excel, Office 365.

Education & Licensure

• Current RN licensure is required.
• Bachelor's degree in nursing or equivalent is preferred.
• CFRN, CEN or CCRN is preferred.

Skills

• Excellent written communication skills.
• Ability to define and identify problems, collect data, establish facts, and draw valid conclusions.
• Ability to respond to inquiries or complaints from customers in a positive and productive manner.
• Ability to calculate numbers, correct entries, and post to records.
• Ability to gather data from hospital and EMS charts, phone calls, emails, colleagues, and internet research, then compile information and prepare reports and letters.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to research local EMS protocols, hospital referrals, and standards of care.
• Ability to review clinical charts and development of constructive feedback.

Pay & Schedule

• Hourly Compensation: $33.65 (this position is bonus eligible)
• Work Schedule: Full Time
• Location: Remote or On-Site, United States