Medical Appeals Specialist - AZ Licensed
Location: Remote
Compensation: To Be Discussed
Staff Reviewed: Thu, Nov 21, 2024
This job expires in: 18 days
Job Summary
A company is looking for a Med Appeals and Grievance Specialist II (remote).
Key Responsibilities
- Research and resolve member and provider appeals, grievances, and corrected claims
- Analyze medical records to determine the appropriateness of requests based on medical necessity and benefit plans
- Maintain accurate records and meet regulatory and compliance timelines
Required Qualifications
- Associate's Degree in a healthcare field or Nursing Diploma
- Active, unrestricted license to practice in Arizona as an RN, PT, or LMSW
- 3 years of experience in clinical and health insurance or healthcare-related field
- 1 year of managed care experience with a focus on Utilization Management, Prior Authorization, Claims, or Medical Appeals
- Intermediate PC proficiency and ability to navigate multiple system applications
COMPLETE JOB DESCRIPTION
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