Medical Necessity Analyst - Pre Services
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About The Position
The Medical Necessity Analyst is responsible for the timely pre-services evaluation of physician-submitted clinical documentation supporting planned or elective procedures. The goal of this evaluation is to ensure that patients' planned healthcare services meet current published insurance payor guidelines, yielding payment without claim denial. After prior authorization is obtained per current facility protocol, the analyst reviews surgical cases in established work queues and analyzes relevant healthcare documentation against current published payor guidelines to ensure it supports the meeting of medical necessity for the proposed procedures. If the healthcare documentation available in the EHR is insufficient, the analyst coordinates with involved healthcare providers and/or their designated associates to ensure the specific, required criteria have been fully documented prior to the delivery of planned healthcare services.
