Hospital Operations Manager - Danbury - beBeeDenialManagement

    beBeeDenialManagement
    beBeeDenialManagement Danbury

    21 hours ago

    Job title: Medical Director Denial Management

    Description

    • Determine strength documentation criteria appeal If case viable attempt peer peer send written appeal if lacking downgrade lower care Adjust level care eg NICU levels ICU levels
    • Maintain working relationship payers via periodic discussions medical necessity Implement CMS Form process help mitigate MA medical necessity denials Send beneficiary appeals grievances Maintain contact CHA Payer Audit Representatives Meeting Periodically review CMS manual re: MA plans keep updated national commercial CMS denial issues RAC Relief RAC summit Modern Healthcare Beckers Medical Economics Keckley Report RAC Monitor etc Pursue/follow State Insurance Commissioner AHA compile issues Review Medicare one-day length stay cases possible addendum Assistant Hospitalist Director DH/NH JK CM recommend possible adjustment provider liable Provide education new Hospitalists employment UR processes IP OP CC44 DM processes documentation peer p
      This position also involves maintaining working relationships with various departments implementing procedures to reduce unnecessary hospital stays.We require someone who can do this successfully

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