• Clinical Follow-up Representative

    Job ID
    2018-21699
    Employment Type
    full-time
    Hours Per Week
    0.00
    Onsite Work Schedule Details
    M-F 8-5
    Address
    1 Boroline Rd
    City
    Saddle River
    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

    Be Inspired. Ignite Change. Transform Health Care. 

    From Patient-to-PaymentSM, nThrive provides all the technology, advisory expertise, services, analytics and education programs health care organizations need to thrive in the communities they serve. Our colleagues share a united passion to help health care organizations strengthen their financial position, which translates to accessible, quality care for all. This passion fuels our drive to innovate and participate in community outreach through the nThrive CARES program. Our colleagues are encouraged to think differently and empowered to make a lasting impact that ensures our health care providers, and our world, are healthy and productive.

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