Appeals Clinician (Monday - Friday)
PacificSource Health Plans(1 month ago)
About this role
The Appeals Clinician accurately represents the clinical component of member and provider appeals, producing concise, evidence-based summaries for determination. The role involves collaborating with internal and external partners, ensuring regulatory compliance, and presenting clinical findings to the Medical Director for final decisions.
Required Skills
- Clinical Review
- Case Management
- Policy Interpretation
- Medical Coding
- Research
- Collaboration
- Communication
- HIPAA Compliance
- Data Analysis
- Lean Methodologies
Qualifications
- Registered Nurse
- Licensed Behavioral Health Specialist
- Current Unrestricted State License
About PacificSource Health Plans
pacificsource.comPacificSource offers health insurance plans for individuals, families, and employers. A Northwest not-for-profit, we put members first.
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