Claims, Appeal, UR Case Management Coordinator

90 Degree Benefits is seeking an experienced person to review case management, utilization review, and appeals functions in a Third-Party Administrator (TPA) setting. In this role, you will oversee and work with our partners for all aspects of our Medical Management processes, claims, and participate in denial hearings in coordination with one of our vendors.

Job Type: Part-time / 20 hours per week / Remote

Key Responsibilities:

• Utilization Review and Case Management Services: Oversee all Medical Management activities. Work closely and collaborate with providers, patients, case managers and claims department in our TPA
• Hearing Participation: Review case files and actively participate in virtual or on-site hearings reviews with payers and administrative bodies

Qualifications & Requirements:

• Nursing experience, Utilization Review and/or Case Management experience is preferred
• Experience working with Third Party Administrators is preferred
• Claims Experience
• Excellent written and verbal communications skills
• Proficiency in Microsoft Excel and Microsoft Word is required

Benefits:

• 401(k)
• Work from home

This position is Part-time/Remote

Benefits:

• 401(k)
• Work from home

Education:

• High school or equivalent (Required)

Language:

• English (Required)

Work Location: Remote