Clinical Appeal Specialist

Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt employs some of the best and brightest minds from around the world. Join a dedicated team of nearly 11,000 who are shaping the future we envision. Moffitt has been recognized as a Best and Brightest Company to Work For in the Nation and is continually named one of the Tampa Bay Times’ Top Workplaces. Summary Responsible for the administration and coordination of the denials review and appeals management processes that includes denials management, claims recovery, and denial root cause analysis. Minimum Required:Associate's Degree in Healthcare, Finance, or other related field* "in lieu of" Bachelor's please review Experience, minimum required below. Minimum Experience/Certification Required:Bachelors Degree plus a minimum of five (5) years healthcare experience and RN required (OR)"in lieu of" a Bachelor's degree you must have an Associates degree plus a seven (7) years healthcare experience preferably in NursingRN license required. Accommodation: LPN's currently in the role of Clinical Denial Specialist will be given a specified time frame (2 years) to obtain the RN licensure Additional Skills/ Specialized Training Required -Computer literate, knowledge of financial data analysis, Medicare and Medicaid regulations, third party reimbursement,and charging and coding guidelines. Intermediate Excel skills. Excellent communication skills both written and verbal

• Proficient in all aspects of reimbursement.
• Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory andadministrative rules).
• Knowledge of managed care industry including payer structures, administrative rules, and government payers-Adept in hospital and insurance reimbursement and billing concepts and procedures, as well as laws and regulationsaffecting payment compliance, denials and appeals recovery.
• Proficiency with various reimbursement methodologies including, but not limited to, Per-Diem, DRG, fee schedule,percentage of charges, and stop loss.
• Proficient understanding of medical coding systems effecting the adjudication of claims payment. These include ICD-9,CPT, HCPCS, DRG, APG, APC, and revenue code structures.
• Proficiently utilizes MS Office applications, including MS Excel and MS Access

Soft Skills -Ability to work collaboratively in a team environment or independently, as applicable.

• Must be able to anticipate obstacles to a goal and initiates appropriate resolution.
• Must have initiative to identify barriers and opportunities and provides solutions through process and operationalimprovements.
• Requires investigation and analytical skills with a proven ability to communicate effectively in both written and verbalformat.
• Able to communicate (both written and verbal) professionally and effectively.
• Requires exceptional attention to detail and demonstrated ability to prioritize work to ensure accuracy and timelycompletion.

Preferred Experience in oncology nursing, utilization review, quality management, and/or recent case managementSoarian experience Salary Range $31.99 - $48.80 Salary ranges posted for this position represent the expected base pay range for the role. Actual compensation may vary based on location and a variety of job-related factors, including experience, skills, education, and internal equity among Team Members in similar positions. We are committed to maintaining fair and equitable pay practices and regularly review compensation to ensure alignment across our workforce. Equal Employment Opportunity Moffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or protected veteran or disabled status. We seek candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence. Reasonable Accommodation Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Moffitt endeavors to make moffitt.org/careers accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact one of the Human Resources receptionists by phone at or by email at . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. .Transparency in Coverage Rule #J-18808-Ljbffr Moffitt Cancer Center