Prior Authorization Appeals Specialist (Fully Remote)

IVX Health, Inc.; United States; Remote; USD 52,000 - 75,000; Full time

Job summary

IVX Health, Inc. is seeking a denial management professional to oversee pre-service authorization denials, coordinate reconsiderations, appeals, and peer-to-peer reviews within required timeframes.

You will interpret payer policies and coverage criteria to determine resolution pathways and obtain supporting documentation. Collaborating with providers, payers, and internal teams, you will analyze denial trends and support process improvements, ensuring timely documentation and accurate

Responsibilities

• Manage pre-service authorization denials and coordinate reconsiderations, appeals, peer-to-peer reviews, and payer exception requests within applicable timeframes.
• Interpret payer policies, medical necessity criteria, and coverage requirements to determine appropriate resolution pathways and obtain supporting documentation.
• Collaborate with providers, payers, and internal teams to resolve complex cases, identify denial trends, and support process improvement.

Job description

• Manage pre-service authorization denials and coordinate reconsiderations, appeals, peer-to-peer reviews, and payer exception requests within applicable timeframes.
• Interpret payer policies, medical necessity criteria, and coverage requirements to determine appropriate resolution pathways and obtain supporting documentation.
• Collaborate with providers, payers, and internal teams to resolve complex cases, identify denial trends, and support process improvement.