Clinical Appeals Reviewer

**Role Overview:** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory requirements. This role involves outreach to appellants or their representatives, obtaining and reviewing medical records, packaging pertinent information into a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full intent of the appeal.

**Work Arrangement:**

+ Remote - Associate can work remotely anywhere in the United States

**Responsibilities:**

+ Process appeals, ensuring compliance with all regulatory milestones
+ Review medical records to identify Hospital-Acquired Conditions (HAC), ensure proper documentation, billing code compliance, and prevent reimbursement errors
+ Outreach to appellants or their representatives to obtain and review medical records
+ Package pertinent infor...