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Samford University McWhorter School of Pharmacy

Birmingham, Alabama

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Optum

Olympia, Washington

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Harris Health System

Houston, Texas

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Optum

Tacoma, Washington

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Northeast Georgia Health System

Gainesville, Georgia

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University of Maryland Medical System

Baltimore, Maryland

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WMCHealth

Warwick, New York

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Optum

San Antonio, Texas

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Northeast Georgia Health System

Braselton, Georgia

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Veterans Affairs, Veterans Health Administration

Brookings, Oregon, Oregon

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AdventHealth

Ormond Beach, Florida

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Clinical Appeals Specialist
DescriptionSummary:This position requires the ability to work independently researching and reviewing inquiries from members and providers. Also requires knowledge of benefit interpretation, claims reviews, CPT and ICD coding. Responsible for analyzing, researching, and managing appeal/grievance inventories from members and providers. Respond to inquiries using verbal and written forms of communication.Research and provide resolution to issues such as claim denials, member and provider complaints, and reconsideration and redetermination requestsReview and respond to complaints, grievances and appeals within the stated time frame for each requestEnsure 95% compliance with the Center for Medicare and Medicaid Se


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