Description
Logistics
This position is full time (40 hours/week) Monday-Friday, 8:30 am – 5:00 pm and will be located at 4101 Percival Road, Columbia S.C., 29219. This role is eligible to work remotely after training (3-4 weeks). Must be able to travel to the Columbia, SC office occasionally throughout the year.
What You Will Do:
Documents the basis of the appeal or retrospective review in an accurate and timely manner and in accordance with applicable regulations or standards. Performs thorough research of the substance of service appeals by both member and provider based on clinical documentation, contractual requirements, governing agencies, policies, and procedures, while adhering to confidentiality regulations regarding protected health information. Performs appeal and retrospective reviews demonstrating the ability to define and determine the precedence of pertinent issue...