Denials Prevention Specialist, Clinician PRN
Job Description: Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical necessity and necessity of continued stay in the inpatient patient care setting and/or discharge to an alternative level of care. • Provide timely referral/appeal determination by accurate use of clinical criteria resources and payor guidelines. • Work under the usage of the Milliman Care Guidelines and or Interqual. • Select appropriate letter language to author appeal letter identification of referrals to the medical director for review. • Communicate directly with providers and health plan Medical Director to facilitate timely authorizations and/or denial reversals. Maintain compliance in turnaround time requirements as mandated by the TAT Standards of the facility and/or CIOX Health Standards. Meet or exceed production and quality metrics, and maintain confidentiality of all files, documents, and records. Apply tot his job