Denials Prevention Specialist, Clinician PRN

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November 20

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Datavant

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Healthcare Insurance • SaaS • Enterprise

Datavant is a company that provides a platform and network focused on making health data secure, accessible, and usable across the healthcare ecosystem. With a focus on data connectivity and interoperability, Datavant facilitates the movement of healthcare records across a vast network of organizations, including hospitals, clinics, health systems, and data partners. Their suite of products and solutions covers areas such as health data exchange, data transformation, and privacy compliance, serving various clients including health plans, healthcare providers, life sciences, and government organizations. Datavant's mission is to advance human health through improved data exchange and analytics.

201 - 500 employees

Founded 2017

⚕️ Healthcare Insurance

☁️ SaaS

🏢 Enterprise

💰 $40M Series B on 2020-10

📋 Description

• Provide timely referral/appeal determination by accurate • 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 • Select appropriate preferred and contracted providers • Provide proper identification of eligibility and healthcare plans • Maintain compliance in turnaround time requirements as mandated by the TAT Standards of the facility and/or CIOX Health Standards • Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely authorizations and/or denial reversals • Maintain and keeps in total confidence, all files, documents and records • Meets or exceeds production and quality metrics • Attend all mandatory meetings and trainings

🎯 Requirements

• Two (2) years managed care experience in UM/CM/CDI Department preferred • Knowledge of CMS, State Regulations, URAC and NCQA preferred • ICD10 and CPT coding a plus • Experienced computer skills, Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus.

🏖️ Benefits

• Health insurance • Flexible work hours