What is Aspirion?

For over two decades, Aspirion has delivered market-leading revenue cycle services. We specialize in collecting challenging payments from third-party payers, focusing on complex denials, aged accounts receivables, motor vehicle accident, workers’ compensation, Veterans Affairs, and out-of-state Medicaid.

At the core of our success is our highly valued team of over 1,400 teammates as reflected in one of our core guiding principles, “Our teammates are the foundation of our success.” United by a shared commitment to client excellence, we focus on achieving outstanding outcomes for our clients, aiming to consistently provide the highest revenue yield in the shortest possible time. 

We are committed to creating a results-oriented work environment that is both challenging and rewarding, fostering flexibility, and encouraging personal and professional growth. Joining Aspirion means becoming a part of an industry leading team, where you will have the opportunity to engage with innovative technology, collaborate with a diverse and talented team, and contribute to the success of our hospital and health system partners. Aspirion maintains a strong partnership with Linden Capital Partners, serving as our trusted private equity sponsor.

What do we need?

The Clinical Nurse Specialist works closely with denial experts to successfully resolve clinical denials received from the government and/or third-party payers. They will efficiently and effectively review all appropriate documentation and clinical guidelines and extrapolate information to formulate persuasive clinical arguments in written appeals for denial resolution. They will conduct data gathering and analysis to assist with identifying client and payer trends, identifying denial prevention opportunities, conduct quality reviews, and assist operations with specialized reviews for inventory management. This role will also assist with the training of new hires and serve as a clinical resource for other team members.  

What will you provide?

• Consistently demonstrates Aspirion’s Mission, Vision and Values
• Analyze medical documentation and extrapolate essential medical information to formulate a clear and concise clinically based, persuasive argument to overturn denials
• Follow claim lifecycle from appeal to adjustment within EMR including drafting of appeal, following up on claim status, and ensuring zero balance resolution
• Locate and correctly apply appropriate recognized medical policies and guidelines
• Completes Nurse Reports for all denial types and ensure denial reasons are accurate and can appropriately assign root causes
• Uses clear and complete communication when documenting in company or client systems
• Captures clinical data elements in order to provide trending and feedback to our clients
• Reviews necessary data and analyzes the information to identify client and payer trends, denial prevention opportunities, conduct quality reviews, and assist Operations with specialized reviews for inventory management and process improvement opportunities
• Serve as a clinical resource for Clinical COE, Legal COE, and Operations COE team members
• Assist in orientation and training of new clinical team members as requested
• Provides clinical support to Payer Relations Managers for accounts escalated to the Payer’s Provider Representatives including attending payer meetings upon request
• Assists in the preparation and/or conducts ongoing education and training on clinical topics for all team members
• Work with Team Leads and Supervisors to ensure client expectations are met
• Meets or exceeds productivity goals set by the Director or Supervisors
• Actively participates in internal and external meetings, as requested
• Adheres to HIPPA guidelines regarding PHI. Maintains work area in a professional and HIPPA compliant state
• Performs additional duties as assigned

Requirements

• Demonstrated understanding/experience with InterQual, Milliman Care Guidelines, and other criteria used for medical necessity determinations
• Proficient in use of Microsoft Office products (Word, Excel, Outlook, PowerPoint, TEAMS)
• Working knowledge of PowerBI reports
• Demonstrates attention to detail with strong critical thinking, problem-solving, and effective decision-making skills
• Must have in depth knowledge of hospital claims, Revenue Cycle, and UM processes
• Strong communication skills (both oral and written)
• Ability to work independently
• Ability to multi-task effectively
• Must have a good understanding and ability to navigate various electronic medical record systems and internal software programs
• Promotes positive attitude and demonstrates flexibility with changes that occur
• Maintains a cooperative relationship with team and other departments. 

Education and Experience

• Current LPN or RN license required
• Minimum 1 year of clinical experience in an acute hospital required
• Minimum 1 year of experience in utilization review, case management, and/or clinical denials management required
• Case Management/Utilization Review or other job-related certification preferred
• 1 year previous experience appealing clinical denials for hospitals required 

Benefits

At Aspirion we invest in our employees by offering unlimited opportunities for advancement, a full benefits package, including health, dental, vision and life insurance upon hire, matching 401k, competitive salaries, and incentive programs.

The US base pay range for this position starts at 63,000 annually. Individual pay is determined by a number of factors including, but not limited to, job-related skills, experience, education, training, licensure or certifications obtained. Market, location and organizational factors are also considered. In addition to base salary, a competitive benefits package is offered.  

AAP/EEO Statement

Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability, or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to.