Job Description
Job description:
Key Responsibilities:
Denials and Appeals Management:
- Review and evaluate denied claims, including payer policies and clinical documentation
- Submit retro-authorizations in response to authorization denials
- Conduct medical necessity reviews and prepare supporting clinical summaries
- Write and submit detailed, well-supported appeals based on clinical documentation and payer guidelines
- Track, document, and follow up on all appeals through resolution
- Maintain accurate and timely communication with payers and internal stakeholders
- Perform research to support appeals and stay updated on payer policies and best practices
Tracking, Reporting, and Trends:
- Monitor and analyze denial trends and root causes
- Escalate patterns and issues to management with recommendations
- Assist in preparing and maintaining reports related to denials ...