Clinical Appeals Consultant (Medicaid & Commercial)

Point32Health, Inc.; Massachusetts; On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Employer-paid life and disability保险

Well-being benefits

Career development and family health

Job summary

Point32Health, Inc. in Massachusetts seeks a highly motivated professional with experience in Appeals & Grievances within managed care, focusing on Commercial plans and Medicaid.

The role acts as a clinical resource across A&G activities and supports the analyst team in medical terminology and care plans related to appeals. The position includes assisting the department trainer with new-hire training on clinical aspects of A&G work and participating in other duties and projects as assigned.

Qualifications

• Understanding of Appeals & Grievances processes in managed care, with focus on Commercial plans and Medicaid.
• Ability to support Analyst team in medical terminology and provider plan of care related to appeals.
• Assist department trainer with new hire training on clinical aspects of A&G work.

Responsibilities

• Serve as key clinical resource for various aspects of Appeal & Grievances work.
• Provide support to Analyst team in developing knowledge of medical terminology and provider plan of care relative to appeal.
• Assist department trainer with new hire training as it relates to clinical aspects of A&G work.
• Other duties and projects as assigned.

Job description

Point32Health, Inc. in Massachusetts seeks a highly motivated professional with experience in Appeals & Grievances within managed care, focusing on Commercial plans and Medicaid.

The role acts as a clinical resource across A&G activities and supports the analyst team in medical terminology and care plans related to appeals. The position includes assisting the department trainer with new-hire training on clinical aspects of A&G work and participating in other duties and projects as assigned.