Conduct pre-service and retrospective Provider and Member Appeals for outpatient and inpatient requests
Job Summary
Conduct pre-service and retrospective Provider and Member Appeals for outpatient and inpatient requests.
Reviews service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrow.
Matching Summary
Conduct pre-service and retrospective Provider and Member Appeals for outpatient and inpatient requests.