Appeals Processing Senior Representative - Evernorth - Remote

+ **Position Summary** The Clinical Coder conducts outpatient post-service administrative claims or appeals coverage determinations (such as bundling reviews) for which they are empowered outside of our company's clinical unit manager program requirements. This role applies all benefit plan limitations or exclusions and applicable federal and state regulatory requirements to each case review, including Patient Protection and Affordable Care Act. The Clinical Coder also keeps all HIPAA regulatory requirements.

**This role is for a Medical Coder; not Appeals Processing.**

+ **Responsibilities**
+ Makes coverage determinations only on retrospective administrative OP claims/appeals such as bundling reviews using standard NAO and claims policies and procedures and company administrative guidelines.
+ Research claims and appeals information, submitted review request letters or referrals and related materials in order to make coverage determinations on retrospecti...