DENIAL MANAGEMENT SPECIALIST

The Denial Management Specialist demonstrates the ability to communicate effectively with all members of the healthcare team, both internal and external. The Denial Management Specialist will assist the Lead Denial Management Specialist with communication of clinically-based appeals between Excela Health and outside payors. This individual will review each case identified for appeal and apply InterQual and other relevant screening criteria, including the Medicare Benefit Policy Manual, to determine the viability of the appeal and manage the appeal process through the various stages as appropriate.Actively promotes a Lean work culture by performing team member duties to encourage consistent use of LEAN principles and processes, including continually seeking work process improvements.