Review patient medical records to determine why claims are denied and prepare compelling appeal arguments using clinical evidence and regulatory guidelines.
Search for supporting evidence and analyze insurance denial trends to provide feedback to hospitals and executive leadership.
Ensure compliance with HIPAA regulations and demonstrate excellent written communication skills in crafting appeal letters and hearing testimony.
PAM Health provides specialty healthcare services through over 70 long-term acute care hospitals, rehabilitation hospitals, wound clinics, and outpatient physical therapy locations in 17 states. With a collaborative culture and a focus on compassionate care, the company employs a dedicated team committed to high-quality patient outcomes and professional growth.
Facilitate improvement in provider-based clinical documentation accuracy to reflect patient acuity and severity.
Conduct concurrent record reviews and formulate compliant documentation queries to improve accuracy.
Educate clinicians and facility management on documentation opportunities and coding reimbursement issues.
Banner Health is a large nonprofit health care system with hospitals, clinics, and research centers across multiple states. They focus on skilled and compassionate care using advanced technology to improve patient outcomes.
Lead daily CDI operations, including staffing, workload balancing, and training for clinical documentation improvement.
Conduct real-time clinical reviews for complex cases and analyze data to ensure quality and accuracy.
Collaborate with physicians and staff to enhance documentation quality and compliance with coding guidelines.
Adventist HealthCare is a faith-based, not-for-profit healthcare organization providing comprehensive services including acute-care hospitals, rehabilitation, outpatient centers, and home care. With over 6,000 employees, they are the largest healthcare provider in Montgomery County, Maryland, focused on extending God's care through physical, mental, and spiritual healing.
Review inpatient and outpatient medical records to ensure accurate and compliant clinical documentation.
Collaborate with physicians and clinical teams to clarify diagnoses and support proper coding.
Maintain productivity targets and contribute to provider education initiatives to improve documentation quality.
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