At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

                        

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

                                    

Job TitleClinical Denial Lead

                        

LocationCleveland

                    

FacilityRemote Location

                     

DepartmentRCM Coding Denials PB-Finance

                      

Job CodeT98835

                     

ShiftDays

                       

Schedule8:00am-5:00pm

                       

Job Summary

                         

Job Details

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. 

  

As a Clinical Denial Lead, you will assist Payer Denial Management Nurses and Coders with complex denials to support optimal clinical and reimbursement outcomes. In this role, you will oversee day-to-day operations and serve as a key resource for the team, maintaining quality, ensuring compliance, and supporting internal team management. Responsibilities include conducting vendor quality audits to ensure alignment with departmental standards, performing internal team audits to assess performance and identify improvement opportunities, and assisting with team management activities such as workload distribution, issue resolution, and training.

A caregiver in this role works remotely from 8:00 a.m. to 5:00 p.m.

Candidates must reside in Ohio or Florida to be considered for this role.

A caregiver who excels in this role will:

Provide management support when the supervisor is unavailable.

Manage the day-to-day operations and act as the key information and education resource for the team.

Work to develop enterprise-wide approaches to problem solving.

Assist the Payer Denial Management Nurses and Coders with complex denials and promote the achievement of optimal clinical and reimbursement outcomes.

Facilitate the appeals process, including monitoring appeal timeframes to minimize controllable loss write-offs.

Review denials and write appeals for defined population.

Identify, develop, and apply process improvement methodologies in evaluating and improving appeal outcomes.

Collaborate with hospital departments identifying denial trends and process improvement opportunities.

Function as the recognized expert serving as the clinical resource for the Coders, Physician Advisor and Nurses on the team.

Lead meetings and participate on enterprise wide committees as needed.

Serve as the preceptor for new hires.

Work with leadership to align goals and visions.

Minimum qualifications for the ideal future caregiver include:

Licensed Registered Nurse (RN) in the State of Ohio, RHIT, RHIA, CCS or CPC 

Certified coder with background in professional coding and denials experience

Three years of Utilization Management or Coding experience

In-depth familiarity with third party billing requirements and regulations and writing appeals

Preferred qualifications for the ideal future caregiver include:  

Bachelor of Science in Nursing (BSN) or Bachelor’s degree in a related healthcare field 

Certification in Case Management and InterQual 

Expertise with InterQual and MCG disease management ideologies 

Physical Requirements:

Ability to communicate and exchange accurate information. 

Ability to perform work in a stationary position for extended periods.  

Ability to work with physical records or operate a computer or other office equipment.  

In some locations, ability to travel throughout the hospital system.  

In some locations ability to move up to 25 lbs.

Personal Protective Equipment:

Follows Standard Precautions using personal protective equipment as required for procedures.

                       

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

Please review the Equal Employment Opportunity poster. 

                  

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities