This position requires the ability to work independently researching and reviewing inquiries from members and providers that also requires knowledge of benefit interpretation, claims reviews, CPT and ICD coding.
Bachelor's Degree and minimum 5 years of relevant experience.
Requirements:
Research and provide resolution to issues such as claim denials, member and provider complaints, and reconsideration and redetermination requests.
Review and respond to complaints, grievances and appeals within the stated time frame for each request
Certify that providers and members are reimbursed accordingly using Medicare reimbursement policies and procedures Requirements.
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