Medical Necessity Specialist
1 week ago
**About the Role**
We are seeking a highly skilled Medical Necessity Specialist to join our team at Medstar. As a key member of our denial management process, you will play a crucial role in reducing financial risk and exposure by appealing denied claims.
**Responsibilities:**
- Coordinate and monitor the denial management and appeals process
- Collaborate with physicians, Utilization Review RNs, Case Managers, revenue cycle personnel, and payers to appeal denials
- Evaluate external denials for medical necessity and coordinate decision-making regarding appeal feasibility
- Develop medical summaries of denied cases for review by hospital administration and possible legal action
- Identify and implement strategies to avoid denials and improve care efficiency through denial review and examination
- Maintain records of concurrent and retrospective denial activity in conjunction with Case Management support staff
- Monitor and track denials and appeal results, coordinating information with Patient Financial Services (PFS)
**Requirements:**
- Associate's degree in Nursing required; Bachelor's degree preferred
- 3-4 years clinical experience required; 2-3 years UR experience in a healthcare setting preferred
- 1-2 years background/experience in hospital audits preferred
- RN license in the District of Columbia or State of Maryland depending on work location upon hire
- Certification in Utilization Review, Case Management, and Healthcare Quality upon hire preferred
**Salary Range:** $87,318 - $157,289 per year
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Medical Imaging Specialist
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Medical Support Specialist
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Medical Imaging Specialist
1 week ago
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Vascular Imaging Specialist
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Medical Travel Radiology Specialist
3 days ago
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Travel Medical Imaging Specialist
5 days ago
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Diagnostic Imaging Specialist
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Travel Medical Imaging Specialist
1 week ago
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Travel Medical Imaging Specialist
19 hours ago
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Travel Medical Imaging Specialist
7 days ago
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Diagnostic Imaging Specialist
3 days ago
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Rosedale, Maryland, United States Aureus Medical Group - Imaging Full timeAureus Medical Group - Imaging is seeking a skilled Radiology Specialist to fill a travel Mammography position in Maryland. With thousands of available travel jobs across the country, we're sure to have the right fit for you.Salary and BenefitsThe estimated payment breakdown for this position is approximately $2812-$3012 per week, with an estimated hourly...
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Medical Imaging Specialist
3 days ago
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Diagnostic Imaging Specialist
1 week ago
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Pharmacy Technician
6 days ago
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Diagnostic Imaging Specialist
1 week ago
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Diagnostic Imaging Specialist
5 days ago
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