Aergo Solutions is the partner of choice to healthcare providers in support of their Revenue Cycle challenges. We solve problems through a customized mix of services, consulting and technology that can change over time to meet any client’s evolving needs.
We work with 300+ providers in 25+ states and bring a client-focused approach that makes each provider feel like our only client. Aergo offers the following products and services; A/R Services, Denials Recovery, Pre-Registration, Managed Care Consulting, Contract Management, and Revenue Cycle Workflow.
We are currently looking for an Appeals Clinician to work remotely for our company.
Essential Duties and Responsibilities:
- Performs retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials.
- Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization.
- Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appeal process.
- Demonstrates proficiency in utilization of electronic tools including but not limited to Microsoft Office.
Minimum Qualifications & Competencies:
- Must possess a valid nursing license (Current, valid RN/LPN/LVN licensure)
- Minimum of 5 years recent acute care experience with the last 2 years in a facility environment
- Medical-surgical/critical care experience preferred
- DRG downgrades and/or coding experience is preferred
- Minimum of 2 years UR/Case Management experience within the last 2 years
- Managed care payor experience a plus either in Utilization Review, Case Management or Appeals
- Patient Accounting experience a plus
Equal Opportunity Employer
Job Type: Contract