Lead Clinical Appeals Coordinator

Company: Absolute Total Care | Location: Remote-WA State | Salary: $34 to $61 per hour | Employment: Full-time | License: Multiple | State licensure: Washington

Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements. Key Details: This is a remote position. Hours are Monday-Friday 8:00 am - 5:00 pm PST. WA State and/or Compact licensure required. Appeals experience and experience as a lead strongly preferred. • Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested. • Prepare reviews for cases that did not meet criteria • Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up • Prepare response letters for