Licensed Professional Counselor of Mental Health, LPCMH
LifeStance Health
Occupational Therapy, Independent Medical Examiner
Dane Street
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Utilize clinical expertise to review insurance appeals and prospective and retrospective claims
- Provide interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care
- Review all medical records and address each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria
- Ensure the rationale for determinations is clear, concise, and contains adequate supporting documentation
- Identify, critique, and utilize current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature
- Provide copies of any criteria utilized in a review with the report in a timely manner and return cases on or before the due date and time
- Make telephone calls as mandated by the state and/or client specifics
- Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
- Attend all required orientation and training and perform other duties as assigned (quality assurance, complaints, regulatory issues, depositions, court appearances, audits)
Requirements
- Board certification required, active practice required
- Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
- Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria
- Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature
- Provides copies of any criteria utilized in a review with the report in a timely manner
- Returns cases on or before the due date and time
- Makes telephone calls as mandated by the state and/or client specifics
- Attends all required orientation and training
- Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits
