necessity issues to determine if an appeal is warranted. Formulate clinical appeals and letters of medical necessity to be sent... appeals to insurers. Maintain the clinical appeals database used for reporting and denial trending. Communicate...
Responsibilities With direct oversight, the Clinical Authorization Specialist: Manages approval process... that all necessary medical information was provided to the third-party payer. If necessary, helps clinical team understand denial...
Responsibilities With direct supervision, the Drug Authorization Specialist: Reviews and monitors the drug..., letters of medical necessity, provider-initiated appeals, etc.). Manages prior authorization reports to ensure appropriate...
Specialist is coordinates the analysis and effective resolution of denied claims with the purpose of reducing overall denials... and increasing revenue. The Reimbursement & Billing Specialist is responsible for prioritizing and managing to resolution denied...