Job description

NRGUSA has an immediate need for an experienced Denials and Appeals Assistant.

The Denials and Appeals Assistant will perform daily operations of administrative support within the Clinical Denials and Appeals Department. Prepare and mail written appeal responses and/or medical records to Third Party Payors, RAC, and all other requestors. Track and enter Medical Necessity denial and appeal data. Collaborates within the multidisciplinary team to expedite appeals.

Responsibilities:

• Coordinates daily with Case Assistant in the Care Management Department for receipt of initial Medical Necessity denials.
• Scan and document denial letters in Soarian DM.
• Enter initial denial code into FMS for reporting.
• Request medical records for Medical Necessity Appeals from HIM through Huron Trac.
• Enter new initial denials on pending Excel tracker to be appealed.
• Prepare envelope and send written appeals with medical records when necessary.
• Inform Manager of Patient Accounts once denial letter is sent to follow-up with payers to ensure receipt of appeal and timely resolution of all outstanding clinical appeals.
• Enter applicable patient care data into 3M, FMS, and Xsolis.
• Collaborates with Clinical Appeals Coordinator for Medical Necessity appeal follow up.
• Perform basic administrative and office duties for Denials and Appeals Department
• Perform other duties as needed

Job Type: Full-time

Pay: $18.00 - $20.00 per hour

Benefits:

• 401(k) matching
• Health insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: One location

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