Minimum of 2 years experience in receiving, documenting, researching and responding to member inquiries, complaints, appeals and/or grievances. Gathers and presents all relevant data of cases for medical review and makes recommendations for resolution and/or determination of next step. Also responsible for coordinating problem resolution for members, providers, and employer groups amongst various internal departments and external resources/contacts. Knowledge of medical terminology ICD-9; CPT; HCPCS; Revenue Codes and ADA Codes. Call Center experiences a plus. […]
Must have behavioral sensitivity...