Researches the substance of complex appeal or retrospective review requests including pre pay and post payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents decisions within mandated timeframes and in compliance with applicable regulations or standards. Perf

Performs routine facility maintenance tasks to ensure company employees have a safe and properly conditioned work environment. Assemble, relocate, and repair free standing or modular office furniture and equipment. Perform general maintenance tasks. Clean equipment, mechanical rooms, and work sites as directed. Perform preventative inspections. Respond to emergency calls

Seeking a RN to function as a Medical Affairs Coordinator . This position if fully remote. The schedule is M F, 9am 5pm. DUTIES Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non covered services and reduce the claims pay

DUTIES Analyzes current operational functions and offers and implements improvements. Maintains databases and extracts data for analysis from multiple systems and departments using various data manipulation and extraction techniques. Runs and reviews reports, analyzing results in support of operational functions. Summarizes findings and communicates results to management.