Clinical Appeals Consultant
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Job Summary
Working remotely in a full-time capacity, the Clinical Appeals Consultant will serve as a key clinical resource for the Appeals & Grievances department, providing support to the Analyst team and collaborating on complex appeals and grievances to enhance member satisfaction.
Key responsibilities
- Serve as a clinical resource for various aspects of Appeals & Grievances work
- Support the Analyst team in understanding medical terminology and provider plans of care related to appeals
- Analyze appeal trends and collaborate with leadership to develop messaging for internal stakeholders
Required qualifications
- Strong understanding of Appeals & Grievances processes in a managed care environment
- Experience with Commercial plans and Medicaid
- Ability to work independently and collaboratively in a team setting
- Clinical knowledge relevant to assessing and consulting on appeals and grievances
- Experience in training or mentoring related to clinical aspects of Appeals & Grievances work
Complete Job Description
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