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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