Clinical Denial Specialist

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This position provides assistance to the Utilization Review and Denial Management team through computer skills, coordination, non-clinical appeal writing, and clerical assistance.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1.High School diploma or equivalent.

EXPERIENCE:

1.Two (2) years training or related experience. One (1) year of administrative support training may substitute for experience.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1.Associate Degree in related field.

EXPERIENCE:

1.Experience with hospital billing.

2.Five (5) years of experience with Microsoft suite of technologies.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.

They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1.Completes non-clinical appeal writing and coordination as directed by leadership.

2.Organizes and manages clinical appeal letter submissions via mail or other portals.

3.Assists with payroll management as directed.

4.Maintains clinical denial tracking and logging through Microsoft or assigned computer programs.

5.Coordinates or assists in the preparation of administrative reports, statistical tables, requisitions, and other data gathering for review by or signature of the Director or Manager.

6.Coordinates, schedules, and reserves meetings as directed.

7.Coordinates reimbursement expense reports as directed by leadership.

8.Manages and distributes incoming mail in a timely manner and coordinates outgoing mail.

9.Coordinates the duplication and collection of materials on a regular basis, filing masters or copies as appropriate.

10. Composes and types correspondence such as letters, memoranda, policies, procedures, reports, etc. from notes, drafts in an accurate, neat and timely manner as assigned and proof reads for accuracy prior to submittal or distribution.

11. Accurately records and transcribes meeting minutes as directed. Minutes are completed within a timely manner and stored in an accessible location.

12. Maintains appropriate records and establishes filing system to ensure the expeditious retrieval so that Director, Manager and staff can accomplish their responsibilities.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.Manual dexterity used in operating standard office equipment.

2.Prolonged periods of sitting.

3.May be required to walk to various areas throughout the department or medical complex. This may require the use of stairs and/or elevators.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.Business Environment.

SKILLS AND ABILITIES:

1.Previous experience with payroll preferred.

2.Basic computer knowledge and ability to operate standard office software.

3.Knowledge of medical terminology preferred.

4.Prior experience with Microsoft Office Suite software applications, including, but not limited to, Word, Excel, Access, Power Point and Outlook is preferred.

5.Good verbal and writing skills.

6.Basic mathematical skills

7.Excellent telephone skills.

8.Ability to type at least 35 WPM preferred

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

WVUH West Virginia University Hospitals

Cost Center:

661 SYSTEM Clinical Denial Management

Address:

Morgantown WV

Core

West Virginia

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.