Job Category: Administration
Job Type: Full-Time
Job Location: LA-Lafayette
Facility Type: Corporate
Shift Type (Clinical Positions): Day Shift
At AMG we offer our employees much more than just a job in the healthcare industry. We offer unique career opportunities for people who are called to make a healing difference in the lives of others and desire to be part of a team that contributes to making a difference each day for our patients. We invite you to join our team and share your gifts and talents. You will have the opportunity to work for an Employee Stock Ownership Plan (ESOP), as AMG is an employee-owned company!
Acadiana Management Group, LLC dba AMG- Integrated Healthcare Management (AMG), an employee-owned company, is hiring a Clinical Appeals Specialist in Lafayette, Louisiana.
- The Clinical Appeals Specialist is primarily responsible for analyzing and interpreting hospital medical records and composing a clinical appeal to the insurance company
- Compose appeals to dispute insurance adverse determinations related to medical necessity
- Construct expedited appeals, inhouse concurrent appeals and 1st and 2nd level retrospective appeals by applying clinical rationale
- Manage assigned workload of accounts so that appeals are submitted timely in accordance with payer timeframes
- Clinical background, minimum LPN/RN license and experience
- Experience in writing clinical appeals
- Hospital experience
- Managed Care experience preferred
- Ability to develop effective working relationships with the facility and payers
- Effective written and verbal communication skills
- Strong analytical, organizational, multi task and time management skills
- Attention to detail
Note: This job description is intended to provide a general overview of the position. It is not an exhaustive list of responsibilities or requirements
AMG is a hospital system committed to our patients, our people, and to the pursuit of healing. As a Top-5 Post-Acute hospital system, we’re known for excellence, integrity, community, and compassion.
Our mission is to return patients to their optimal level of well-being in the least restrictive medical environment. We accomplish this through a multi-disciplined approach that includes aggressive clinical and therapeutic interventions, as well as family involvement. Our high staff to patient ratio ensures individualized attention. Our nurses, therapists, and physicians work with each patient to obtain the best possible outcomes.
Acadiana Management Group, LLC is an equal opportunity employer.