Insurance/Attorney/In House/Saint Louis, Missouri
Location: St. Louis, Missouri
Description: GCC Consulting is currently seeking to employ Insurance/Attorney/In House/Saint Louis, Missouri right now, this career will be placed in Missouri. Further informations about this career opportunity kindly see the descriptions. Claims Denial Consultant HRS Duties: Will manage the claims denial department for company. Oversee process to ensure timely submission ! of medical records as well as claim appeal letters. Write claim appeal letters and legal briefs according to evidence in the medical record and defined appeal process. Maintain electronic trail of all medical records and associated correspondence. Review entire medical record of patient requiring appeal in order to determine whether the case is viable (winnable) on appeal. Compose all appeal letters for HRS. Letter formats to include Redetermination letters, reconsideration letters, briefs, for Administrative Law Judge and position Statements. Final Notice of Hearing form/brief with OMHA field office and communicate details of hearings scheduled to appropriate individuals. Conduct pre-hearing with medical expert to ensure they are able to articulate the compelling arguments related to the case as well as briefing them regarding ALJ Hearing/Medical testimony etiquette. Conduct all ALJ hearings representing RehabCare as their attorney. Monitor and present all appeal decisions! and denial statistics to management. Work with key leaders of! finance team regarding the claims denial process in order to develop a method regarding claims denials that will be efficient and effective. Regularly review periodicals, web sites and other media for changes in current guidelines. Provide educational material relate to types of claims and errors identified in internal and external audits. Recommend projects that promote documentation improvement reducing risk of denied claims.
Qualifications: A Bachelor's degree in Nursing, OT or PT, Master's degree is required for Speech Language Pathology. A Juris Doctorate degree required. Licensed by or eligible for licensure in respective state. Barred Attorney will be considered. 5+ years of clinical experience. 1-3 years of experience in legal setting. Knowledge of all payer regulations and standards across the continuum of care. Frequent use of computer systems. Ability to articulate the patient s story found in the medical record into a strong appeal letter. Abili! ty to review medical records, noting compelling arguments in preparation for pre*-hearing with medical expert. Ability to communicate effectively at all levels of the organization. Skilled in developing and conducting training programs. Knowledgeable of current regulatory environment and ability to process and train new regulations. Ability to teach and train new information. Ability to maintain up-to-date knowledge of new clinical developments. Working knowledge of each of the three rehab disciplines. Excellent documentation skills. Some travel may be required.
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If you were eligible to this career, please send us your resume, with salary requirements and a resume to GCC Consulting.
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This career will be started on: Thu, 14 Nov 2013 14:11:16 GMT
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