Clinical Denials Specialist (Remote, Remote, US)

• Role: Clinical Denial Specialist
• Schedule: M - F 8 AM - 4:30 PM EST

GENERAL SUMMARY:

The goal of the Clinical Denial Specialist is to successfully manage claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, and other clinically related denials, as assigned. The specialist will review claims and make recommendations for claim resubmission, retro authorization, written appeal or if no action is needed.

The Clinical Denial Specialist will write / submit professionally written appeals including arguments based on the clinical documentation, payer medical policies and contract language. The appeals will be submitted timely and tracked for outcome and trends.