Conduct inbound and outbound calls to healthcare providers Handle medical claims review and approval for reimbursements Provide clinical patient information as per request Fi…
Perform a variety of concurrent review of patient’s clinical information and retrospective utilization management reviews for efficiency Evaluate the patient’s situation against t…
Comprehensively review and evaluate appeal and grievance requests to identify and classify member and provider appeals. Determine eligibility, benefits, and prior activity related…
Analyze eligibility of medical claims of patients Handle both inbound and outbound calls for matters related to health insurance claims Coordinate with providers and specialists …
Analyze eligibility of medical claims of patients Handle both inbound and outbound calls for matters related to health insurance claims Coordinate with providers and specialists …
Perform quality audits across all functions of utilization management operations, reviewing completed work in comparison to established documented procedures to determine accuracy.…
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