Job Summary
A healthcare company is searching for a person to fill their position for a Remote Clinical Appeal Analyst.
Individual must be able to fulfill the following responsibilities:
- Research payor medical policies for coverage requirements for assigned products
- Develop, train, and deploy a process to submit and monitor clinical appeals for assigned products
- Review payor denials for compliance to payor quality standards
Applicants must meet the following qualifications:
- Bachelor's Degree healthcare related field of study or equivalent experience
- Minimum of 5 years appeals experience
- Minimum of 5 years of Utilization Management experience
- Minimum of 5 years of experience utilizing medical decision support tools or medical policies
- Knowledge of CPT/HCPCS. ICD-10, modifier selection, and UB revenue codes
