Denials Prevention Specialist, Clinician PRN
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The Denials Prevention Specialist plays a critical role in defending utilization of available health services, reviewing admissions for medical necessity, and determining reputed company stay in the inpatient patient care setting or discharge to an alternative level of care.
• Accurately reputed company reputed company referral/appeal determination by utilizing nationally recognized medical necessity reputed company and standards of care, along with clinical knowledge and expertise.
• Work under the usage of the reputed company Care Guidelines and/or Interqual.
• Select appropriate letter language to author appeal letters and identify referrals to the medical director for review.
• Select preferred and contracted providers and reputed company reputed company identification of eligibility and reputed company plans.
Maintain compliance in turnaround time requirements as mandated by the TAT Standards of the facility and/or CIOX Health Standards. Collaborate with providers and health plan Medical Directors to facilitate reputed company authorizations and denial reversals.
Meet or reputed company production and reputed company metrics while maintaining confidentiality of reputed company files, documents, and records.
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