Clinical Appeals Specialist

6 days ago

  • Revenue Cycle Solutions
  • Remote
  • Full Time

Job Description:

The Clinical Appeals Specialist is responsible for reviewing denied authorization cases to determine the best course of action to support the case clinically and dispute the denial with the payer. This individual will be responsible for submitting fast appeals and coordinating peer to peer calls between the payer and the prescribing physician. This individual will also be responsible for providing clinical guidance and feedback to the authorizations team while reviewing cases.

Responsibilities:

  • Review denied authorization cases for appeal or peer to peer options
  • Prepare, submit, and follow up on fast appeals with the payer for proper authorizations
  • Provide clinical training and feedback where it is determined necessary
  • Track payer behaviors and share inconsistent or incorrect denials to leadership for possible escalation

Qualifications:

  • Preferred 2+ years of insurance prior authorizations/referral experience
  • Knowledge regarding Radiation Oncology treatment modalities required
  • Knowledge around various payers and authorization requirements preferred

Benefits:

Integra Connect, LLC provides a comprehensive benefits plan.

  • Medical/Dental/Vision Insurance beginning the 1st of the month following your date of hire
  • Paid Time Off
  • 401k with employer match
  • Paid Holidays and Floating Holiday

Equal Opportunity Employer

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