Specialist Clinical Denials Appeals

Purpose of Job

The Clinical Denial Claims Specialist serves as an essential support role in navigating the complexities of the denial process. The position facilitates daily operational support and plays a pivotal role in empowering physicians through comprehensive education in clinical documentation and utilization reviews processes. Additionally, this role will provide accurate clinical documentation as it directly impacts reimbursement, compliance, and patient outcomes. The Clinical Denial Claims Specialist role ensures that documentation meets regulatory standards which significantly reduces the risk of denial. ensuring that Ridgeview maintains its financial integrity while delivering unparalleled care.

• Ability to communicate in the English language for effective written and verbal correspondence to complete job functions as mentioned above.
• Attention to detail, strong writing skills, clinical insight, and an updated knowledge of healthcare guidelines.
• Effective teamwork, communication, problem solving, and an understanding of payer policies and revenue management strategies.
• Proactive communication and an acute sense of clinical awareness.
• Interpersonal communicate, mentoring, and a deep understanding of clinical documentation best practices.
• Critical analysis, a firm grasp of medical guidelines, and decision-making.
• Detail orientation, clinical coding and documentation proficiency, and regulatory compliance.
• Commitment to continuous learning and adaptability.
• Ability to meet and maintain the necessary background checks as aligned with position functions.