Clinical Denial/Utilization Management Assistant
About The Position
The Clinical Denial/Utilization Management Assistant provides support to the Clinical Denial Management and Utilization Review teams. The assistants are responsible for the maintenance and utilization of EPIC work queues that drive payer notification and authorization for patient stays. The associate communicates with payers via telephone, fax, or email, and is responsible for ensuring clinical requests are sent in a timely manner and in a thorough fashion. This role is pivotal in the clinical denial appeal process. Provides support before the creation of the appeal and after the appeal is sent to the payer. The Assistant helps with tracking of key information related to the life span of the clinical appeal.
Requirements
- Certifications:
- Education:
- Work Experience:
Responsibilities
- Communicates effectively with Clinical Denial Management and Utilization Review teams to ensure denial letters are addressed in a timely manner.
- Reviews denials sent by payers and documents them into the Dragonfly software, EMR and/or tracking tool as appropriate to ensure appropriate tracking is maintained.
- Communicates with Clinical Denial Management and Utilization Review teams to help create strong processes and efficiencies.
- Submits all appeal documents to the payer accurately and timely.
- Organizes and maintains all clinical appeal documents, databases, and records in a systematic way.
- Reviews appealed cases in a systematic and timely fashion to ensure payment is received and notifies Clinical Denials Management team of new findings of review.
- Contacts insurance provider as directed when more information is needed.
- Gathers data for reporting purposes.
- Screens incoming calls, faxes or other digital communications related to clinical denials and directs it to the appropriate area.
- Perform projects, reviews and handles reports as assigned.
- Interacts with hospital, provider, and financial staff regarding determinations, appeals, and denials and gives direction as necessary.
Benefits
- A comprehensive benefits package for team members and providers.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
