Clinical Follow-up Representative

Job ID
2018-21644
Employment Type
full-time
City
Saddle River
Hours Per Week
0.00
State
NJ

Overview

The DMS Clinical Follow-Up Representative will assist in the recovery of lost revenue for client hospitals through oversight of the clinical appeals process. The individual will assist in the identification of denial trends to maximize recoveries.

Responsibilities

  • Differentiates between clinical vs. technical denials through EOBS, letters and data mining
  • Identifies payer, UM agent and hospital’s managed care contract governing clinical denial
  • Reviews managed care contracts against application of rates, provisions and terms
  • Reviews applicable timeframes governing the appeal process
  • Contacts appropriate third party for outcome of clinical appeal
  • Evaluates appeal outcome for next steps (logs recovered funds, supports uphold decision or initiates 2nd level appeal)
  • Investigates overturned discrepancy dollars. Confirms the ability to log funds with unexpected outcomes
  • Manages assigned workload of accounts through timely follow up and astute record keeping

Qualifications

 

  • Four-year degree
  • Knowledge of/experience working with managed care contracts
  • Experience working with customer support/client issue resolution management
  • Strong analytical acumen
  • Strong multi-tasking skills
  • Proficiency with MS Office
  • Excellent oral and written communication skills

Preferred Skills

  • Benefits/fund administration experience

About nThrive

nThrive is the leader in providing end-to-end revenue cycle services, technology and education solutions. Previously known as MedAssets, Precyse, Equation and Adreima, each formerly a leader in its own right, we’ve combined our talents and capabilities into a single enterprise. At nThrive, we are people who are passionate about empowering health care for every one in every community. We work together to transform financial and operational performance, enabling health care organizations to thrive.
 
nThrive is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.

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