G&A Case Specialist

California  ‐ Onsite
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Description

Summary
  • The G&A specialist will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment.
  • This position will provide resolution of complaints in compliance with CMS, DHCS, DMHC, MBMIB and NCQA regulatory requirements.
  • The G&A specialist reviews pre-service authorizations, concurrent and post service medical necessity; benefit coverage appeals and reconsideration, and complex provider disputes.
SKILLS:

Skills:
  • HS Diploma
  • Some college
  • Computer skills
Start date
n.a
From
Synectics
Published at
09.05.2015
Project ID:
901556
Contract type
Freelance
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