Clinical Appeals Author

Clinical Authorization SpecialistCompany ProfileLKN Strategies is an established healthcare BPO provider with locations in the US, Philippines, and India. LKN is an employee-centric company that offers its employees competitive salaries, robust benefits packages, incentive bonuses, best-in-industry training, professional development, work-from-home...

We are seeking a detail-oriented and experienced Prior Authorization Specialist to manage  the full lifecycle of prior authorizations (PAs) for medical services. The ideal candidate will be responsible for timely submission, meticulous follow-up, and effective resolution of all prior authorization requests and subsequent appeals. This role is critical in...

Medical Prior Authorization-Insurance Verification SpecialistPosition Summary:The Prior Authorization Specialist plays a crucial role in the healthcare industry by ensuring that medical services, procedures, and medications are approved by insurance companies or third-party payers before they are rendered or prescribed. They work closely with healthcare...

Performs quality audits on clinical reviews needed to resolve and process appeals. Provides guidance on preparing case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal. Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards....

Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria,...

Experience these Xtraordinary benefits when you join Med-Metrix8-Hour Shifts, Fixed Weekends OffDay 1 HMO with 2 of your dependents covered for FREEMedical Cash AllowanceRice AllowanceClothing AllowanceFree Lunch DailyPaid Time OffTraining and Staff DevelopmentEmployee Engagement ActivitiesOpportunities for Internal MobilityThe Appeals Writer supports the...

Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.Roles and Responsibilities:Prepares case reviews for Medical Directors by researching the appeal,...

Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Roles and Responsibilities: Prepares case reviews for Medical Directors by researching the appeal,...

"Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.Roles and Responsibilities:Prepares case reviews for Medical Directors by researching the appeal,...

Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals. Provides guidance on preparing case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal. Ensures timely review, processing, and response to appeal in accordance with...