Clinical Denial/Utilization Management Assistant

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Provide assistance to the Clinical Denial Management and Utilization Review teams.

• Manage and utilize EPIC work queues to facilitate payer notifications and authorizations for patient stays.

• Engage with payers through telephone, fax, or email communication.

• Ensure that clinical requests are submitted accurately, thoroughly, and in a timely fashion.

• Assist in the clinical denial appeal process prior to appeal creation and after appeals have been sent to payers.

• Monitor key information throughout the entire duration of clinical appeals.

• Coordinate with teams to guarantee that denial letters are addressed without delay.

• Analyze payer denials and record them in Dragonfly, the EMR, and/or tracking tools.

• Submit appeal documents with accuracy and timeliness.

• Organize and uphold appeal documents, databases, and records.

• Review appealed cases and inform the Clinical Denials Management team of any new findings.

• Contact insurance providers for any additional required information.

• Compile data for reporting purposes.

• Screen incoming communications related to clinical denials and route them appropriately.

• Execute assigned projects, reviews, and reports.

• Collaborate with hospital, provider, and financial staff, providing direction as needed.

⛳️ Requirements

• Proficiency in maintaining and utilizing EPIC work queues.

• Ability to communicate effectively with payers through telephone, fax, or email.

• Competence in submitting clinical requests accurately, thoroughly, and promptly.

• Skill in reviewing and documenting denials in Dragonfly software, EMR, and/or tracking tools.

• Capability to organize and manage clinical appeal documents, databases, and records.

• Aptitude for gathering data for reporting purposes.

• Expertise in screening and directing incoming calls, faxes, and digital communications.

• Ability to interact with hospital, provider, and financial staff concerning determinations, appeals, and denials.

• Qualifications, certifications, education, and work experience are not specified.

🏝️ Benefits

• Comprehensive benefits package.

• Equal Opportunity Employer.