Senior Validation Specialist Part Time jobs

The MHN Clinical Validation Appeals Specialist (part-time/ 20 hours per week) is responsible for conducting a timely and comprehensive review of the medical record and composing a convincing, defensible written appeal letter based on supportive clinical documentation, authoritative and widely accepted diagnostic standards/criteria, pointed rebuttals to the auditor/payer's denial rationale, and evidence-based guidelines and references. The position must possess and incorporate into their appeal letters a foundational knowledge Analyze denied claims to identify appealable opportunities based on clinical documentation and payer policies. Meet appeal letter response due dates. Analyze and interpret regulatory guidelines and Payer contracts. Draft concise, persuasive appeal letters using clinical evidence, coding guidelines and MHN internal policies and procedures to support overturned decisions. Researches and reviews medical literature an coding references and literature to develop arguments for appeal. Develops and drafts documents for administrative hearings in collaboration with relevant MHN staff. Prepares witnesses for administrative hearing testimony and attends the hearing with relevant witnesses. Based on trends, develops and delivers educational materials to the relevant health care providers, i.e., physicians, nurses, dieticians, and others. Communicate with healthcare providers, coders, and revenue integrity teams to gather necessary documentation. Participate in strategy meetings to address systemic denial patterns and recommend process improvements. Drafts first and all subsequent appeal letters to reviewing companies and/or Plan providers. Pursues Peer to Peer reviews of denials when allowed and appropriate. Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors, and internal/external customers. Maintain up-to-date knowledge of payer requirements, clinical guidelines, and regulatory changes impacting claims. Educate clinical and administrative teams on documentation practices to reduce denial rates.