Clinical Appeals Specialist

Welcome to BJC HealthCare, where we are dedicated to providing exceptional patient care through innovation and collaboration. We are currently seeking a highly motivated and detail-oriented Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will play a crucial role in ensuring the accuracy and efficiency of our healthcare billing process. Your expertise and knowledge in medical coding and insurance regulations will be essential in identifying and resolving denied claims. This is an excellent opportunity for individuals with a strong clinical background and a passion for advocating for patients' financial rights. If you possess excellent communication skills, exceptional problem-solving abilities, and a commitment to accuracy and compliance, we encourage you to apply for this exciting opportunity.

1. Review and analyze denied claims to identify the reason for denial and determine the appropriate course of action.
2. Utilize knowledge of medical coding and insurance regulations to accurately appeal denied claims.
3. Communicate with insurance companies, healthcare providers, and patients to gather necessary information for appeal.
4. Collaborate with internal teams, including billing and coding departments, to ensure accurate and timely submission of appeals.
5. Keep up-to-date with changes in insurance regulations and policies to ensure compliance.
6. Document all appeal activities and outcomes in accordance with company policies and procedures.
7. Serve as a resource for healthcare providers and insurance companies regarding appeals processes and regulations.
8. Provide education and training to billing and coding teams on appropriate appeal procedures and best practices.
9. Advocate for patients' financial rights by ensuring their claims are accurately processed and reimbursed.
10. Maintain a high level of accuracy and attention to detail in all appeal activities.
11. Stay organized and prioritize workload to ensure timely resolution of appeals.
12. Collaborate with other Clinical Appeals Specialists to share knowledge and best practices.
13. Participate in departmental meetings and trainings to stay informed of company policies and procedures.
14. Provide excellent customer service to all stakeholders involved in the appeals process.
15. Adhere to all HIPAA regulations and maintain patient confidentiality.

According to JobzMall, the average salary range for a Clinical Appeals Specialist in St. Louis, MO, USA is between $60,000 and $85,000 per year. This range can vary depending on the specific job title, years of experience, and the employer. Some factors that may contribute to a higher salary in this field include advanced education, specialized skills, and working for a larger healthcare organization.

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, serving metro St. Louis, mid-Missouri and Southern Illinois. In 1993, Barnes-Jewish Inc., an urban, academic medical center affiliated with Washington University School of Medicine; and Christian Health Services, a suburban community hospital network, merge to form BJC Health System.