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Moffitt Cancer Center

Cancer care, research, and education center

Clinical Appeal Specialist

Clinical Support & Patient AdministrationUpdated on Nov 11
Full-timeRemote in USA$31.99 - $48.80Remote

About the Job

Requirements

  • A bachelor's degree and at least five years of healthcare experience are required, along with an RN qualification; alternatively, an associate degree and at least seven years of healthcare experience are accepted in lieu of a bachelor's degree, preferably in nursing.
  • An RN license is required.
  • Computer literacy and knowledge of financial data analysis, Medicare and Medicaid regulations, third-party reimbursement, and charging and coding guidelines are required.
  • Intermediate Microsoft Excel skills are required.
  • Proficiency in reimbursement, including benefit investigations, payer reimbursement policies, regulatory rules, and administrative rules, is required.
  • Knowledge of the managed care industry, including payer structures, administrative rules, and government payers, is required.
  • Knowledge of hospital and insurance reimbursement and billing concepts and procedures, and laws and regulations affecting payment compliance, denials, and appeals recovery, is required.
  • Proficiency with reimbursement methodologies including per diem, diagnosis-related groups (DRG), fee schedules, percentage of charges, and stop loss is required.
  • Understanding of medical coding systems affecting claims payment adjudication, including ICD-9, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), DRG, ambulatory payment groups (APG), ambulatory payment classifications (APC), and revenue code structures, is required.
  • Proficiency with Microsoft Office applications, including Microsoft Excel and Microsoft Access, is required.
  • Ability to work collaboratively in a team environment or independently, as applicable, is required.
  • Ability to anticipate obstacles to goals and initiate appropriate resolutions is required.
  • Initiative to identify barriers and opportunities and provide solutions through process and operational improvements is required.
  • Investigation and analytical skills, with the ability to communicate effectively in written and verbal formats, are required.
  • Professional and effective written and verbal communication is required.
  • Exceptional attention to detail and the ability to prioritize work to ensure accuracy and timely completion are required.

Responsibilities

  • Administer and coordinate denial review and appeals management processes, including denial management, claims recovery, and denial root cause analysis.

Desired Qualifications

  • Experience in oncology nursing, utilization review, quality management, and/or recent case management is preferred.
  • Soarian experience is preferred.

About the Company

Moffitt Cancer Center

Cancer care, research, and education center

Moffitt Cancer Center is a health care organization focused on cancer prevention, treatment, research, and education in Tampa, Florida. It delivers patient care, conducts scientific research, and provides education to advance the fight against cancer. The center’s model combines direct cancer treatment with ongoing research and training to improve outcomes, rather than relying on a single service line or product. Its approach distinguishes it from others by integrating comprehensive clinical care with translational research and education, aiming to translate discoveries into better prevention, diagnosis, and therapies for patients. The goal is to reduce cancer incidence and improve survival by moving discoveries from the lab to the bedside and training the next generation of cancer specialists.

Company size
5,001-10,000
Company stage
Grant
Total funding
$10K
Headquarters
Tampa, FL
Founded
1984

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