Clinical Appeals Expert
Company: VirtualVocations
Location: San Diego
Posted on: September 3, 2024
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Job Description:
A healthcare consulting firm is seeking a Clinical Appeals &
Grievances Expert for a remote position.
Key Responsibilities:
Design and implement efficient workflows for Appeals & Grievances
compliance and operational effectiveness
Provide guidance and support to team members, analyze data, and
prepare reports on A&G processes
Engage with cross-functional teams to resolve complex cases and
enhance A&G operations quality
Required Qualifications:
2+ years of experience managing Appeals & Grievances in a health
plan
Strong understanding of CMS regulations
Based in East Coast or Central Time Zone
Recent experience with care management software, preferably
GuidingCare
Clinical degree background as a clinician, nurse, or similar
Keywords: VirtualVocations, San Diego , Clinical Appeals Expert, Healthcare , San Diego, California
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