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    Medical Necessity Appeals Specialist - Nashville, United States - Integrated Oncology Network, LLC

    Integrated Oncology Network, LLC
    Integrated Oncology Network, LLC Nashville, United States

    1 week ago

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    Description
    Partnering With Physicians To Provide Best In Class Patient Care

    Founded in 2002, Integrated Oncology Network is committed to helping our physicians deliver the right care, at the right time and in the right setting.

    We strongly believe that preserving the independent practice of medicine where patients are cared for closer to home and surrounded by our dedicated clinicians yields better outcomes.

    By creating a care continuum between our clinicians, patients and their support networks we deliver an unparalleled approach to the patient's care journey.


    Essential Functions:
    Logs, tracks, and processes appeals and grievances

    Conducts the medical review activities needed to resolve and process clinical appeals and claims.

    Understands and interprets applicable medical terminology, clinical procedures, regulations and policies.

    Constructs effective appeal letters using medical justification to support appropriate reimbursement.


    Reviews applicable medical records and assesses clinical data to investigate and resolve disputes over the medical necessity for services, approvals, pre-certifications, or other cases.

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