Denials Prevention Specialist, Clinician PRN
Denials Prevention Specialist A Denials Prevention Specialist at Datavant will effectively defend utilization of available health services by reviewing admissions for medical necessity and discharging patients to alternative levels of care. • Main Responsibilities: • Provide timely referral/appeal determination by accurately using nationally recognized medical necessity criteria and standards of care, along with clinical knowledge and expertise. • Work under the usage of Milliman Care Guidelines and/or Interqual to select appropriate letter language to author appeal letters. • Select preferred and contracted providers. • Identify eligibility and healthcare plans. • Maintain compliance with turnaround time requirements as mandated by the TAT Standards of the facility and/or CIOX Health Standards. Requirements: • Two years managed care experience in UM/CM/CDI Department preferred. • Knowledge of CMS, State Regulations, URAC, and NCQA preferred. • ICD10 and CPT coding a plus. • Experienced computer skills, Word, Excel, Outlook, and experience working in a health plan medical management documentation system a plus. Apply tot his job