Clinical Appeals Cover Letter

Please consider me for the clinical appeals opportunity. I am including my resume that lists my qualifications and experience.

In the previous role, I was responsible for monitoring of cases involving medical decisions and quality of care or service, and ensures all cases are completed in accordance with State and Federal regulatory requirements for timeliness.

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Strong practical knowledge of quality improvement methods and their application at the functional level in multiple operations settings and clinical areas
• Knowledge of quality and regulatory standards such as NCQA, HEDIS, CMS
• Capable of providing in-service education to Operations resources on quality issues based on data outcomes or industry standards
• Experience with quality standards and proven experience in coordinating Quality activities
• Experience with CMS Medicare and requirements
• Direct and proven successful skills in technical understanding, promoting process improvement, developing standards, and managing processes
• Clinical data analysis and reporting experience
• Experience leading clinical quality initiatives

I would like to submit my application for the clinical appeals opening. Please accept this letter and the attached resume.

In the previous role, I was responsible for consultation and expertise in the area of specific federal and state reimbursement systems.

Please consider my experience and qualifications for this position:

• Working knowledge of personal computers including spreadsheet software
• RHIT, RN or paralegal
• Experience working in a matrix environment with responsibility to multiple stakeholders
• Experience writing clinical appeals to a variety of payers
• Intermediate level proficiency in Excel and PowerPoint
• Experience in billing, collections, or appeal writing
• Knowledge of related NY state and federal regulations highly desirable
• Knowledge of the New York state ART 44 PHL, Chapter 13, and federal regulatory environment

I am excited to be applying for the position of clinical appeals. Please accept this letter and the attached resume as my interest in this position.

Previously, I was responsible for feedback to attending and consulting physicians regarding level of care, length of stay, and quality issues.

Please consider my qualifications and experience:

• Acute managed care experience preferred
• Certification in Case Management, Quality Management, or Utilization Management preferred
• Current knowledge of the rules and regulations as they relate to State and Federal Government and 3rd Party Payors
• Experience in reviewing charts and documentation to effectively provide clinical reasons why an insurance company should pay for services
• RHIA, RHIT, CCS, CPC or other licensed/accredited health care professional specific to scope of contract
• Experience with Electronic Medical Records, prefer Cerner knowledge
• Prior experience with Behavioral Health Managed Care
• Prior experience with Optum Operations

Please consider me for the clinical appeals opportunity. I am including my resume that lists my qualifications and experience.

Previously, I was responsible for monitoring of cases involving medical decisions and quality of care or service decisions; ensures all cases are completed in accordance with state and federal regulatory requirements including timelines.

My experience is an excellent fit for the list of requirements in this job:

• Prior experience creating and managing to balanced performance scorecards
• Prior experience managing teams on Quarterly Variable Compensation Programs
• Proficiency in iCUE, Linx and MyMetrics
• Familiarity with hospital applications and basic Microsoft Office and Windows applications
• Communication - communicates clearly and concisely, verbally and in writing, including utilizing proper punctuation and correct spelling
• Physician License in good standing without any restrictions
• Previous experience with Physician to Physician Outreach on Injured Workers
• Working knowledge of governmental and managed care payers

I am excited to be applying for the position of clinical appeals. Please accept this letter and the attached resume as my interest in this position.

In the previous role, I was responsible for ethical and technical review of protocols so that all institutional, state, and federal guidelines are met and that the PI and designee understand how those requirements are met and their responsibilities in continuing compliance with those guidelines.

Please consider my experience and qualifications for this position:

• Knowledge of claims payment process and claims data system (MHS)
• Experience working within a PBM company or managed healthcare system
• Experience with Medicaid claims
• Experience in reading and understanding legislation to drive operationalization
• Intermediate or better proficiency in MS Word, MS Excel, Adobe Professional and PowerPoint
• Experience with grievances, appeals, denials
• Medicare reporting experience
• Computer experience in Microsoft Office (Word and Excel)