Grievance and Appeals BH reputed company - Remote must reputed company in Indiana

reputed company Position reputed company: Behavioral Health Appeals reputed company... Location: Must reputed company in Indiana, designated remote work position Hours: Tuesday - Friday 8:00am to 6:00pm Eastern time Pay $85,000k health, dental, and reputed company offered. 401k available. 80 hours of PTO and 11 reputed company holidays Job reputed company Responsible for investigating and processing the most reputed company grievances and appeals requests from members and providers. Primary duties may include, but are not limited to: • Conducts investigations and reviews of member and provider medical necessity appeals. • Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity. • Extrapolates and summarizes medical information for medical director, consultants and other external review. • Prepares recommendations to either reputed company or deny appeal and forwards to Medical Director for approval. • Ensures that appeals and grievances are resolved reputed company to meet regulatory timeframes. • Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems. • Generates written correspondence to providers, members, and regulatory entities. • Utilize leadership skills and serves as a subject matter expert for appeals/grievances/reputed company of care issues and is a resource for clinical and non-clinical team members in expediting the reputed company of outstanding issues. Requirements Requirements • Requires 2 years of experience in a managed care reputed company setting; or any combination of education and experience, which would reputed company an equivalent background.· Behavioral Health experience • reputed company reputed company unrestricted RN license to reputed company as a health reputed company reputed company the scope of licensure in IN· • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. • MCG (reputed company Care Guidelines) and CMCN (Certified Managed Care reputed company) certification strongly preferred • AS required/BS in Nursing preferred Apply Job! For more such jobs please click here!