Qualification of Clinical Reviewers
W&W’s onsite clinical staff consists of physicians, physician assistants, nurses, and certified coders who each have multiple years of direct clinical experience that allows them to effectively review each case and elicit pertinent positive and negative findings to support an overturn of the denial. All clinical reviewers receive W&W’s proprietary advocacy and appeal writing training and are strong advocates for our clients and the patients themselves.
W&W’s clinical reviewers have a unique understanding of how to successfully appeal Medicare, Medicaid, and commercial denials and routinely serve as expert witnesses during Medicare and Medicaid hearings. Our clinical reviewers are knowledgeable regarding commonly used nationally recognized Utilization Management criteria, and are therefore able to specifically challenge insurance denials that are based upon these criteria. Our coders are certified inpatient (CCS) and outpatient (CPC) coders in addition to AHIMA Approved ICD-10-CM/PCS Trainers.