Are you looking to enhance your skills in managing appeals and denials?


Our comprehensive guide breaks down the key responsibilities and provides you with the knowledge and tools needed to excel in this critical aspect of healthcare management. Get your free copy today and take your expertise to the next level.

Key Responsibilities Covered:

Validates appeal intake determinations regarding timeliness, member benefits, employer group, and provider contract provisions for each appeal. Documents information in appropriate system.

Process incoming payments accurately applying them to the appropriate customer accounts.

Collaborating Effectively: Gain tips on working with coding specialists, appeal nurses, physician reviewers, and others to reach timely decisions on appeals.

Collecting and Cataloguing Documentation: Discover how to gather and organize supporting documentation to formulate effective appeal recommendations.

Managing Accounting Software: Optimize workflow and enhance information management using programmed accounting software.

Analyzing Claim Coding and Processing: Understand how to review claim coding, processing history, medical policy, reimbursement policies, and regulatory and legal requirements.

Overseeing External Review Set-up: Get insights into setting up appeals for external review organizations, including document collection, coordination, and communication with all parties.

Coding and Documenting: Learn best practices for coding documents according to company procedures and accurately documenting information in the appropriate system.