Position Title: Clinical Review Clinician - Appeals
Location: Remote
Duration: 6 Months | Possibility to extend or convert
Schedule: 8-5 EST or CST time zone-weekend rotation required.
PR: $30-40.00/HR
Responsibilities:
Team handles various types of authorization and claim review requests from various markets nationwide.
Processing clinical reviews to ensure members have the best outcomes and access to care needed.
Help reduce provider abrasion by processing retrospective claim reviews
Licensure
Must haves:
Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals
Nice to haves:
Medicare Appeals Experience
Best vs. average:
Productivity expectations are set based on the platform.
Disqualifiers:
Not having a valid/active RN/LPN license
Top 3 must-have hard skills
Utilization Management or Appeals review background (1 plus year)
Medicare NCD/LCD and InterQual/Milliman Software (1 plus year)
Retrospective claims clinical reviews (1 plus year)
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