Clinical Appeals Strategist

Point32Health, Inc.; Boston (MA); In loco; USD 70.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

Dental coverage

Vision coverage

Retirement plans

Life and disability insurance

Descrizione del lavoro

Point32Health is seeking a motivated professional to support Appeals & Grievances activities within a managed care setting. The role focuses on providing clinical resources for various aspects of Appeals & Grievances work, supporting training, and assisting analysts in understanding medical terminology and the provider plan of care relative to appeals.

Ideal candidates will have a grasp of commercial plans and Medicaid, and will contribute to ongoing process improvements.

Competenze

• Understanding of Appeals & Grievances processes in managed care environment.
• Experience with commercial plans and Medicaid is preferred.
• Clinical aspects of A&G work familiarity helpful.

Mansioni

• Provide support to Analyst team in developing knowledge and understanding 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.

Conoscenze

Appeals & Grievances knowledge

Medical terminology understanding

Descrizione del lavoro

Point32Health is seeking a motivated professional to support Appeals & Grievances activities within a managed care setting. The role focuses on providing clinical resources for various aspects of Appeals & Grievances work, supporting training, and assisting analysts in understanding medical terminology and the provider plan of care relative to appeals.

Ideal candidates will have a grasp of commercial plans and Medicaid, and will contribute to ongoing process improvements.