- Robert Half Office Team (Minneapolis, MN)
- …Are you looking for a rewarding remote role in healthcare administration? This Clinical Appeals Representative position offers the opportunity to make ... a meaningful impact while working from the comfort of your home. As a Clinical Appeals Representative , you will play a key role in managing the intake and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …needs across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and ... and eligibility in a call center environment. * Conducts comprehensive clinical assessments; gathers, analyzes, synthesizes and prioritizes member needs and… more
- Highmark Health (St. Paul, MN)
- …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... obtain necessary and/or additional information when necessary. + Consult with staff clinical pharmacist for guidance and assistance as necessary. + Document all… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …domains, including utilization management, prior authorization, claims, denials, and appeals . Their work goes beyond extraction; it involves interpreting nuanced ... as Network and Pharmacy, ensuring data is pulled using the most representative methods. They also support high-risk regulatory reporting, where precision and speed… more