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Nurse Appeals - Remote - Mason, Ohio - (PS15327)
Location: Ohio, United States
Requisition #: PS15327
Post Date: About an hour ago
Your Talent. Our Vision. At Anthem, ..
... complex cases against perpetrators of healthcare fraud in order to recover ... client funds paid on fraudulent claims. Primary duties may include, but ... of facility, professional and pharmacy..
... on medical record documentation for claims and/or appeals to ensure diagnostic ... medical necessity Maintain incoming pended claims, electronic inquiries and medical records ... review and decision maker Prepare..
... internal and external customers Production Claims Responsible to ensure all claims are submitted for processing have ... Provider to properly adjudicate through FACETS. Responsible for managing target turnaround .....
... as provider data representative in claims editing decisions and implementation and ... ensure that it yields appropriate claims processing Assist in servicing key ... diagnosis and resolution of complex..