Clinical Appeal/Denial Writer

Welcome to Ovation Healthcare!

At Ovation Healthcare, we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions.

The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.

We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork.

Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit https://ovationhc.com.

At Ovation Healthcare, we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions.

The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.

We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork.

Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit https://ovationhc.com.

Essential Functions

• Clinical appeal writer conducts the medical review activities needed to resolve and process clinical appeals and claims.
• Reviews applicable medical records and assesses clinical data to investigate and resolve disputes over the medical necessity for services, approvals, pre-certifications, or other cases.

• Understands and interprets applicable medical terminology, clinical procedures, regulations, and policies. Documents cases according to guidelines and standard procedures.
• Prepares the documentation required for further medical review, hearings, and different appeal processes.
• Responsible for submission of clinical appeals for all payors, service types, and denial reasons.
• Understands reimbursement methodology impacting payment variance including: DRG downgrade, line item denials, service level, and fully denied accounts.
• Work effectively with denial management team and denials analyst to appeal all denials referred.
• Supporting projects and initiatives of the Denials Management Team, to include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Provides precise documentation of all actions taken on accounts worked.
• Maintains client and/or position specific daily productivity and quality expectations.

Required Skills and Experience

• Healthcare background is required, preferred to have knowledge in revenue cycle.
• The ability to work in