Clinical Denials Appeals

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 ...