Clinical Appeals Analyst
E-Verify Program
full-time
Posted on:
Location Type: Remote
Location: North Carolina • South Carolina • United States
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Salary
💰 $73,698 - $117,917 per year
About the role
- Provide clinical consultation with non-clinical staff within the Appeals Department
- Coordinate all aspects of the appeals process to ensure compliance with medical necessity criteria and other requirements
- Analyze complex/non-routine member and provider appeals
- Present analysis and documentation to appropriate physician committee and BCBSNC leadership
- Provide written documentation of case determinations and handle complaints/grievances as defined by the federal government
Requirements
- Registered Nurse in the state of North Carolina
- 3 years of clinical experience
- Licensed in the State of North Carolina
Benefits
- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
clinical consultationanalysisdocumentationcommunication
Certifications
Registered Nurse