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Appeals And Denials Specialist
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- The Appeals and Denials Specialist is responsible for triaging and writing DRG downgrades and clinical validation appeal letters for multiple clients.
- The Appeals and Denials Specialist will ensure appropriate action is taken within appeal deadlines.
- This position collaborates with the Appeals and Denials team and other departments as needed.
- Performs review of the medical record including documentation, reports, flowsheets, and test results, applying evidence-based criteria related to DRG and clinical validation denials
- Collaborates with Accuity Physician and Accuity CDI in appropriately identified clinical denials requiring communication to the Accuity clinical review teams
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