Clinical Appeals and Denials Specialist
Join Swift-Up as a Clinical Appeals and Denials Specialist and play a pivotal role in ensuring patients receive the care they deserve. In this dynamic position, you will review, analyze, and appeal denied medical claims, working closely with healthcare providers, insurers, and legal teams to maximize reimbursements and improve patient outcomes.
Swift-Up is a leading healthcare technology company based in Bali, dedicated to revolutionizing the way medical claims are processed. With a team of over 100 professionals, we are committed to providing innovative solutions that enhance efficiency and accuracy in the healthcare industry.
As a Clinical Appeals and Denials Specialist at Swift-Up, you will be part of a collaborative team that handles a high volume of medical claims daily. You will use advanced software such as ClaimScape, Eclipsys, and Meditech to streamline the appeals process and ensure compliance with regulatory requirements.
📋 Tanggung Jawab Pekerjaan
- Review and analyze denied medical claims to identify areas for improvement and appeal decisions.
- Collaborate with healthcare providers, insurers, and legal teams to gather necessary documentation and evidence for appeals.
- Utilize advanced software such as ClaimScape, Eclipsys, and Meditech to process and track appeals efficiently.
- Ensure compliance with regulatory requirements and industry standards.
- Provide regular reports and updates on the status of appeals to stakeholders.
- Stay updated with the latest trends and best practices in medical claims processing.
- Train and mentor junior staff on the appeals process and software usage.
- Participate in continuous quality improvement initiatives to enhance the efficiency of the appeals process.
🎓 Kualifikasi & Syarat
- Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
- Minimum of 3 years of experience in medical claims processing, appeals, or a related field.
- Certification in Medical Billing and Coding (CPC) or similar is a plus.
- Strong understanding of healthcare regulations and compliance requirements.
- Excellent analytical and problem-solving skills.
- Proficiency in English, both written and spoken.
- Experience with software such as ClaimScape, Eclipsys, or Meditech is a plus.
- Ability to work well under pressure and meet tight deadlines.
🛠️ Keahlian
Kirim lamaran sekarang sebelum batas waktu.🚀 Lamar Sekarang