Denials Prevention Specialist, Clinician PRN
Job Description: • Provide timely referral/appeal determination by accurate • Work under the usage of the Milliman Care Guidelines and or Interqual • Select appropriate letter language to author appeal letter • Identification of referrals to the medical director for review • Select appropriate preferred and contracted providers • Provide proper identification of eligibility and healthcare plans • Maintain compliance in turnaround time requirements as mandated by the TAT Standards of the facility and/or CIOX Health Standards • Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely authorizations and/or denial reversals • Maintain and keeps in total confidence, all files, documents and records • Meets or exceeds production and quality metrics • Attend all mandatory meetings and trainings Requirements: • Two (2) 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, experience working in a health plan medical management documentation system a plus. Benefits: • Health insurance • Flexible work hours Apply tot his job