PHRN Nurses | Utilization Management or Clinical Appeals | Denials
Aces Call Center Jobs Inc.
Conducts comprehensive reviews of utilization data, including claims, authorizations, and medical records, to analyze and take appropriate action
Requests clinical data from patient's attending physician as necessary for re-authorization process.
Adheres to guidelines and follows protocol in place.
Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
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