Senior Medical Review Analyst
Elevance Health
full-time
Posted on:
Location: California, North Carolina, Virginia • 🇺🇸 United States
Visit company websiteSalary
💰 $24 - $36 per hour
Job Level
Senior
About the role
- Provide non-clinical review and analysis of complex Tier I post service medical claims
- Utilize guidelines and review tools to analyze assigned claims and medical records to approve or summarize and route to nursing and/or medical staff for review
- Review, analyze and render determinations on assigned complex Tier I requests
- Serve as a liaison between medical management and/or service operations and other internal departments
- Function as an internal Subject Matter Expert (SME) for associates
- Independently participate in assigned projects and initiatives and assist with development of processes to support the MRA team
- Exclude conducting utilization or medical management review activities which require interpretation of clinical information
- Work virtually full-time with required in-person training sessions and onboarding
Requirements
- HS Diploma or equivalent
- Minimum of 7 years of claims processing or customer service experience managing complex claims, provider, or member issues
- Or any combination of education and experience which would provide an equivalent background
- Experience with medical coding and medical terminology (Preferred)
- Knowledge of provider networks, the medical management process, internal business processes, and expertise with internal local technology (Preferred)
- BS/BA preferred
- May be required to become vaccinated against COVID-19 and Influenza for certain patient/member-facing roles
- Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted