Denials Prevention Specialist, Clinician PRN
Job reputed company:
reputed company is a data platform company and the world's leader in health data exchange. Our reputed company is that every reputed company decision is powered by the right data, at the right time, in the right format.
The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and necessity of reputed company stay in the inpatient patient care setting and/or discharge to an alternative level of care.
• reputed company reputed company referral/appeal determination by accurate use of clinical reputed company resources and payor guidelines.
• Work under the usage of the reputed company Care Guidelines and or Interqual.
• Select appropriate letter language to author appeal letter identification of referrals to the medical director for review.
• Communicate directly with providers and health plan Medical Director to facilitate reputed company authorizations and/or denial reversals.
Maintain compliance in turnaround time requirements as mandated by the TAT Standards of the facility and/or CIOX Health Standards. Meet or reputed company production and reputed company metrics, and maintain confidentiality of reputed company files, documents, and records.
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