Clinical Appeals Manager, Medical Plaza II

Job description

Primary Location: Med Plaza II - UMC Address: 250 E Liberty Louisville, KY 40202 Shift: First Shift (United States of America) Job Description Summary: Manage team of 10-12 clinical reviewers and oversee Facility clinical claim denials by developing strategies to overturn insurance payor processing and proactively determine root cause and solutions to prevent denials for the UofL Health System. Clinical support will include pre-bill edits, payment denials, and pre/post-payment audits from insurance carriers or designated third party vendors as related issues such as medical necessity, experimental determinations, medically unlikely edits, non-covered services, and/or documentation. This position will collaborate with Revenue Cycle Leadership, Case Management and clinical service areas, Payor Relations and Contracting Department. Job Description: Position Summary and Purpose Manage team of 10-12 clinical reviewers and oversee Facility clinical claim denials by developing strategies to overturn insurance payor processing and proactively determine root cause and solutions to prevent denials for the UofL Health System. Clinical support will include pre-bill edits, payment denials, and...