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Average Salary
Updated: 05/25/2013
Appeals Supervisor:
Assists the Appeals Manager in coordinating all appeal and grievance activity for the organization. Investigates and researches time-sensitive appeals cases regarding medical health needs, patient care issues, transportation, medications, durable medical equipment, or home care by using medical investigative skills.... [+] More
Appeals Supervisor:
Assists the Appeals Manager in coordinating all appeal and grievance activity for the organization. Investigates and researches time-sensitive appeals cases regarding medical health needs, patient care issues, transportation, medications, durable medical equipment, or home care by using medical investigative skills. Requires graduation from an accredited school of nursing (either LPN or RN) with two years of managed care experience.
Serves as a liaison between enrollees in a health plan and providers, pharmacies, and other medical entities involved in the appeals process. Ensures departmental compliance with applicable regulations. Tracks appeal and grievance activity. Prepares formal hearing briefs and may appear at hearings on behalf of the organization. Ensures that appeals and grievances are entered into the database, categorized, and processed within required timeframes. Receives investigation results and responds to member appeals and grievances. Identifies quality issues. (Source: eDOT Job Description) [-] Less
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