Logan Health

This role is responsible for obtaining prior authorizations for facility and professional charges by submitting necessary codes and medical records to insurers according to departmental protocols. Key duties include prioritizing requests, handling denials and appeals, tracking actions, and communicating issues to leadership.

This critical role focuses on identifying and resolving insurance claim denials to secure accurate reimbursement and reduce financial loss by analyzing claims, submitting appeals, and researching Explanation of Benefits. Responsibilities also include coordinating documentation submission, identifying denial trends, collaborating with internal teams, and maintaining accurate documentation of all appeal actions.

The specialist reviews all daily inpatient and observation admissions across the system, evaluating documentation to determine appropriate admission status and reassessing patients throughout their stay to ensure continued level of care criteria are met. This role involves collaborating with advisors, case management, and insurance partners to facilitate authorizations and medical necessity reviews.

Medical Billing & Collections Specialist ensuring accuracy and timeliness of claims