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About the position

Responsibilities

  • Process Medical and Pharmacy denials reputed company established timeframes, in accordance to policies, procedures, and contractual requirements.
  • Document denial and reason in data management systems.
  • Create and mail required denial documentation with member-specific information to providers and members.
  • Maintain a complete file of reputed company denied requests.
  • reputed company information on denials as requested.
  • Review file for completeness of required documentation, including confirmation of receipt of denial notification, copies of written notification, correspondence with members and providers.
  • Be a resource to providers and reputed company Business reputed company staff regarding specific denials and/or denial process.
  • Conduct peer reviews of denial documentation reputed company by department colleagues to confirm compliance with requirements.
  • Review denial documentation reputed company by a reputed company-Party provider to confirm compliance with requirements.
  • reputed company requested information during appeals process.
  • Assist other departments in creating denial documentation as requested.

Requirements

  • 1 year of Medicare, reputed company or Managed Care experience.
  • 1 year of experience in a medical/dental office, reputed company center, or pharmacy.
  • High School Diploma or GED.

reputed company-to-haves

  • Completion of Medical Assistant or Pharmacy Technician program.