Clinical Specialist

• Identify and prepare clinical appeals for government, managed care organizations, and other payors
• Provide assistance and guidance in maintaining the charge description master for the INTEGRIS Health system
• Assist the Director of Revenue Recovery with training and development of recovery staff on clinical and non-clinical payment issues
• Oversee and manage the INTEGRIS System clinical denial management process
• Identify denial and payment trends and help develop plans to maximize reimbursement
• Participate in the Utilization Management Committee to report denial issues and develop preventive strategies with physicians
• Analyze, prepare, and distribute monthly denial reports to hospital leadership
• Respond to utilization management clinical denials for Medicare and Medicaid programs
• Support Case Management and hospital departments with clinical expertise regarding payor and patient clinical denial inquiries
• Assist with chargemaster development, implementation, maintenance, and audits
• Analyze denial trends and facilitate cross-departmental collaboration to improve processes and develop best practices
• Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve them
• Maintain practical knowledge of government and managed care payer rules, regulations, and requirements
• Report to the assigned Corporate Manager

Explore RN Clinical Reimbursement Specialist at INTEGRIS Health. Review requirements and application details.