Clinical Resource Management Appeals Specialist
This position maximizes hospital revenue by working collaboratively with Appeals Coordinators, Physician Advisors, Clinical Resource Coordinators (CRC), Case Managers, CRM leadership, Professional Support Services (PSS), Finance, and appropriate external contacts to ensure timely processing of denials and appeals. Incumbent will be actively involved in multi-disciplinary process improvement projects to maximize reimbursement. This position coordinates, supports, and participates in creating Utilization Management Committee processes and activities; position also identifies and escalates data trends and prepares CRM reports and denials dashboard for Committee review. Participates in Revenue Cycle Committee report preparation and attends meetings as required. EDUCATION: High school diploma and some college experience or equivalent required. Associate's degree is preferred. PRIOR EXPERIENCE: Approximately three to four years of progressively more responsible experience in either healthcare reimbursement, managed care, and/or resource utilization. Solid working knowledge of word processing, spread sheet and database management computer software and applications. Proven ability to prioritize work, manage multiple competing priorities, and work in a fast-paced environment with a high volume of time-sensitive information. CERTIFICATION/REGISTRATION/LICENSURE: No special certification, registration, or licensure is required.