Summary Researches the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents
Summary Researches the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents
Job Description SummaryThe Senior Data Architect, Research Analytics will lead the South Carolina Clinical and Translational Science (SCTR) Institute’s data and reporting strategy and will engage with enterprise IS data leadership and teams to strategize for