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Hybrid Clinical Denials Appeals Analyst

Opportunity to join one of Maryland’s most renowned and established healthcare systems. This organization is committed to excellence in

patient care and offers an inclusive work environment where professional growth is limitless. This position will be a hybrid-based schedule, offering

candidates the ability to share time working from home and in the Annapolis, MD office.

Location : Annapolis, MD

Pay Rate : $40-50/HR (Depends on Experience)

Work Model : Hybrid (Schedule To be Determined)

Schedule : Monday – Friday (Normal Business Hours)

Position Summary: As a Clinical Denial Appeals Analyst, you will be responsible for the identification, mitigation, and prevention of clinical denials. This position reviews all initial clinical denials to determine the next steps and conduct appeals as appropriate, such as by reviewing medical necessity, responding to authorization concerns, and/or reconciling coverage-related issues. The clinical denial appeals specialist also works to prevent future clinical denials by communicating with clinical and revenue cycle leadership about denial root causes, such as documentation gaps or insufficient charge capture and helps develop and implement staff education and process changes.

Benefits:

• Exposure : Ability to join and gain exposure to a large healthcare organization and work alongside many other healthcare professionals, giving one many career advancement opportunities.

• Hybrid Based Schedule : Ability to split time working from home and in the office!

• Competitive Pay: Enjoy a competitive salary commensurate with your experience and skills.

• Comprehensive Benefits Package:

• 401K Retirement Plan

• Health Insurance, Vision, and Dental Insurance

• Promotions and Salary Evaluations: Regular performance evaluations with opportunities for salary increases and career advancement.

Responsibilities:

• Reviews clinical denials and initiates appeals process, if determined appropriate according to internal guidelines

• Conducts medical necessity reviews, based on denial root cause, and prepares any required clinical documentation summaries to accompany appeals.

• Communicates with payer representatives or other stakeholders in appeals process (e.g., mediators, arbitrators, legal counsel)

• Helps present appeals arguments to Administrative Law Judge, when appropriate

• Otherwise monitors and follows up on appeals throughout entire process, determining next steps to ensure appeals either result in an overturned denial or have proceeded as far as possible.

• Identifies gaps in clinical documentation and works with clinical staff to develop and implement quality improvement and staff education initiatives.

Qualifications:

• 3-4+ Years of experience required in one of the following areas: clinical, case management, denials, billing.

• Certification in at least one of the following is required: Certified Healthcare Chart Auditor, Certified in Professional Utilization Review, Certified Case Manager, Certified Documentation Specialist, Certified Coder, or Auditor.

• Proficient in medical terminology and able to interpret patient medical records.

• Proficient in EHR and other systems used by the organization (Epic, Cerner, MEDITECH, Microsoft suite)

• Strong time management and prioritization skills

• Ability to communicate effectively, especially with clinical staff members.

Pay and Benefits

The pay range for this position is $40.00 - $50.00

• Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in Annapolis,MD.

Application Deadline

This position will be accepting applications until Jan 22, 2025.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.