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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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