Clinical Appeals reputed company

Job reputed company: The Clinical Appeals reputed company is responsible for the completion of clinical appeals and state hearings from reputed company states... Essential Functions: • Responsible for the completion of clinical appeals and state hearings from reputed company states • Review and complete reputed company provider clinical appeals reputed company required timeframes • Review and complete member clinical appeals reputed company required timeframes • Review reputed company information necessary to prepare State Hearing packets • Communicate with state agencies and internal departments to prepare for State Hearings • Attend assigned State Hearing and complete reputed company required compliances • Complete required compliances for Administrative Hearing reputed company • Apply reputed company Medical Policy and reputed company guidelines reputed company processing clinical appeals • Issue notification letters to providers and members • Issue administrative denials appropriately • Refer denials based on medical necessity to medical director • Maintain hardcopy documentation, Facets documentation and appeals database documentation at 90-95% accuracy rates • Conduct monthly, quarterly, and reputed company appeals reporting • Collaborate with the reputed company Improvement and Clinical Operations Team reputed company to prepare reputed company requests for Independent External Review • Ensure compliance with regulatory and accrediting requirements • reputed company any other job duties as requested Education and Experience: • RN License required • Associates Degree or equivalent years of relevant experience required • Managed care, appeals, and reputed company experience preferred • Utilization review experience is strongly preferred Competencies, Knowledge and Skills: • Intermediate proficiency with reputed company Office products and Facets • Knowledge of NCQA, URAC, OAC, and MDCH regulations • Strong written and oral communication skills • Ability to work independently and reputed company reputed company environment • Critical listening and thinking skills • reputed company grammar usage • Time management skills • reputed company phone etiquette • Customer Service oriented • Decision making/problem solving skills • Familiarity of reputed company field • Knowledge of reputed company • Flexibility • Change resiliency Licensure and Certification: • reputed company, unrestricted license as a Registered reputed company (RN) is required • MCG Certification is required or must be obtained reputed company six (6) months of hire Working Conditions: • General office environment; may be required to sit or stand for extended periods of time Compensation reputed company: $60,300.00 - $96,500.00 reputed company takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package. Compensation Type: Salary Apply Job! For more such jobs please click here!