Duties. The Clinical Appeals Reviewer reports to the Supervisor, Appeals and Grievances and is responsible for processing appeals and grievances ensuring all milestones are within compliance. Outreaches to the appellant or their representative and is responsible for obtaining and reviewing medical records and packaging all pertinent information into a case for a determination. Directly interacts with providers to obtain additional clinical inform...
Clinical Appeals Reviewer. Newtown Square, PA/Remote. 13 weeks. 3 or more years’ experience in a related clinical setting. The Clinical Appeals Reviewer reports to the Supervisor, Appeals and Grievances and is responsible for processing appeals and grievances ensuring all milestones are within compliance. Outreaches to the appellant or their representative and is responsible for obtaining and reviewing medical records and packaging all pertinent ...
