SCA Appeals Representative I
Core
Reviewing, analyzing, and processing non-complex pre and post service grievances and appeals requests related to clinical and non-clinical services, quality of service, and quality of care issues for federal populations.
Role type
Claims appeals representative
Builds
Approved or summarized grievance and appeal decisions routed to medical staff
Domain
Healthcare claims administration and federal programs
Deliverable
client delivery
Required skills
Grievances and appeals processing, claims processing, customer service, business writing, medical records analysis
Preferred skills
Medical coding, medical terminology, provider networks understanding, medical management process knowledge, internal business processes knowledge, local technology proficiency
Responsibilities
Review and analyze grievances and appeals in accordance with regulatory requirements and internal policies, conduct research using guidelines and review tools, route summaries to nursing and medical staff, serve as liaison between grievances/appeals and medical management/legal/service operations
Seniority
Individual Contributor, Entry Level