In my previous role, I managed clinical denials by reviewing denied claims, identifying root causes, and collaborating with clinical and billing teams to resolve issues. I utilized data analysis tools to track denial trends and implemented process improvements to reduce denial rates. My efforts resulted in a 15% reduction in denials over six months, improving revenue cycle efficiency and ensuring compliance with payer requirements.

I stay informed by subscribing to industry newsletters, attending webinars, and participating in professional organizations like HFMA. I also regularly review payer updates and communicate with payers directly to clarify policy changes. This proactive approach ensures I can adapt workflows and educate teams promptly, minimizing the risk of denials due to non-compliance.

I focus on thorough documentation review, ensuring all clinical and billing details align with payer requirements. I craft clear, evidence-based appeal letters and include supporting documentation like medical records and coding references. By maintaining open communication with payers and leveraging internal expertise, I’ve successfully overturned 80% of appealed claims, maximizing revenue recovery.

I prioritize denials based on factors like dollar amount, denial reason, and aging. I use denial management software to track and categorize claims, ensuring timely resolution. By delegating tasks to team members and setting clear deadlines, I maintain efficiency while addressing high-priority cases first, ensuring minimal impact on cash flow.

I foster collaboration by conducting regular meetings to discuss denial trends and root causes. I provide training to clinical staff on documentation best practices and work with billing teams to ensure accurate coding. By creating a culture of shared accountability, we’ve reduced preventable denials and improved overall revenue cycle performance.