Remote Jobs in Springfield

The Appeals and Grievances Clinical Coordinator is responsible for supporting the clinical team to ensure timely and accurate processing of cases. The clinical coordinator properly sets up case files for clinical review as needed and conducts general appeal research and filing including but not limited to organizational determination research, requesting member medical records, organizing documentation, preparing written summaries, scheduling the case, processing the review of the case, documentation of the appeal resolution and sending complete case files to external review organization as required by regulatory guidelines. The appeals and grievances may be related to all lines of business (Medicaid, Medicare, Commercial, etc.). • Prepare cases for the clinical team by gathering documentation, loading evidence, and making calls to members and providers. • Perform administrative activities including but not limited to generating and printing determination and authorization notification ...