Job Summary: Decrease the monies lost to insurance companies due to denials. Generate appropriate appeals, both retrospective and concurrent, based on medical necessity criteria. 2. Identify opportunities to improve reimbursement. 3. Provide direction to the Case Management staff in relation to denials/appeals which includes training and monitoring of staff competency in performing insurance reviews. Responsibilities: The following is a summary of the essential functions of this job. The employee may perform other duties, both major and minor, that are not mentioned below; and specific functions may change from time to time. Review and identify medical necessity denials appropriate for appeal.