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Lincolnwood

    Clinical Documentation Specialist - Lincolnwood, United States - Aperion Care

    Aperion Care
    Aperion Care Lincolnwood, United States

    5 hours ago

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    Description

    Vacancy: Clinical Documentation Specialist


    Professional Profile: RN or LPN


    ROLE OVERVIEW:

    In this position, you will have a key role in analyzing and addressing audits from commercial and governmental payers. Your main responsibility will involve efficiently and precisely handling audit requests.


    MAIN RESPONSIBILITIES:

    • Identifying the underlying reasons for clinical claim rejections.
    • Applying clinical judgment to determine necessary actions for revenue recovery or defense.
    • Developing well-crafted appeals for denied claims or payer audits.
    • Participating in conferences and appeal hearings as required.
    • Spotting trends to rectify issues and enhance internal processes.
    • Engaging in team calls and meetings.
    • Maintaining an appeals log accurately.
    • Working closely with Accounts Receivable and Case Management to ensure correct and timely payment of claims.
    • Completing other assigned tasks and duties.

    REQUIREMENTS:

    • Active RN or LPN license.
    • Minimum of 2 years' experience in audit and appeals processing (experience in long-term care is preferred).
    • Familiarity with Revenue Cycle processes such as admission, billing, payments, and denials.
    • Understanding of additional documentation requests, audits like Target Probe and Educate, and care level principles.
    • Knowledge of payor medical necessity criteria.
    • Ability to analyze medical records and apply guidelines effectively.
    • Excellent written and verbal communication skills to convey information clearly.
    • Strong interpersonal skills to communicate persuasively and handle feedback.
    • Effective organizational abilities and attention to detail.
    • Demonstrated judgment in interpreting results and suggesting appropriate actions.
    • Self-motivated with the ability to work independently and maintain confidentiality.
    • Proficiency in Microsoft Office applications.

    Please be aware that the duties and qualifications described may not cover all aspects and could be updated by the organization if necessary.

    PHYSICAL REQUIREMENTS:

    The physical criteria necessary for performing this role's essential functions.

    Reasonable adjustments can be arranged for individuals with disabilities.

    • Intermittent movement throughout the workday.
    • Capability to lift, push, or pull at least 25 lbs.
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