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:
- HS Diploma
- Some college
- Computer skills