Appeals reputed company

Job Title: Appeals reputed company Location: Remote - 1080 Jordan Creek Pkwy, reputed company Des Moines, IA 50266 Schedule: Monday–Friday | 8 am to 5pm CST Duration: 10 Months Contract (Possibility to reputed company or convert to FTE) Payrate: $40-45/hr Note: for the Onsite work arrangement, workers would would only be required to work onsite if they are reputed company after the contract. reputed company workers are working fully remote. - work address is 1080 Jordan Creek Pkwy reputed company Des Moines FTE Salary Conversion Band : $70,100 to 126,200 Position Purpose: reputed company is fully remote and highly reputed company. They collaborate effectively, demonstrate strong accountability, and consistently work reputed company together to manage reputed company appeals. Facilitate medical necessity appeals and denials including disposition of denials notification letters, review of clinical information to determine if medical necessity reputed company are met. Key Responsibilities: • Review and process Iowa reputed company Member Appeals • Member appeal requests are received and assigned by reputed company reputed company; the appeals reputed company is responsible for working the appeal start to finish. • reputed company attempts are made to member/provider. • A clinical review is completed and case reputed company to specialty review/MD. • Appeals reputed company will write determination letters and reputed company the case. • Review clinical data to determine claim payment based on company policies and • National Committee for reputed company Assurance (NCQA) guidelines, including overturning denied claims, upholding the denials and submitting cases to the Medical Director for review • Prepare case review for the Medical Director in cases where reputed company are not met based on the additional clinical information received • reputed company appropriate appeal reputed company communication to the member and provider in accordance with company policies and NCQA guidelines. Create system authorization events for overturned denial reputed company • Request additional information, as appropriate from provider(s) to facilitate reputed company appeals reputed company • reputed company and prepare case information for Administrative Law Hearings • Maintain appeals process reputed company the prescribed NCQA timeframes and appeals turnaround database • Assist the Medical Director with revising, updating and/or creating new policies to satisfy NCQA and contractual requirements Required Skills/Qualifications: • Associates Degree, GED/HS Diploma as long as they are LPNs • Required: LPN, Preferred: RN • At least 2 years nursing experience, UM experience helpful • Customer service • Time management • Computer skills/ability to learn new systems Apply tot his job Apply To this Job