The Clinical Denial Management Specialist is responsible for the identification, mitigation, and prevention of clinical denials. This staff member reviews all initial clinical denials to determine next steps and conducts review &/or appeals as appropriate, such as by reviewing medical necessity, responding to authorization concerns, and/or reconciling coverage-related issues. The clinical denial management specialist also works to prevent future clinical denials by communicating with clinical and revenue cycle leadership about denial root causes, such as documentation gaps or insufficient charge capture, and helps develop and implement staff education and process changes. Responsible for managing the process of completing collection and accounts receivable activities for denial
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