Analyst, Appeals

BlueCross · W@H South Carolina

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About this role

Summary Researches the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents decisions within mandated timeframes and in compliance with applicable regulations or standards. Description…

Excerpt only. The full posting is on the employer’s careers site.

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