Palmetto GBA

The analyst researches complex appeal and retrospective review requests to determine if services meet medical necessity guidelines. They document decisions accurately while adhering to clinical policies, contractual requirements, and confidentiality regulations.

The Medical Director provides administrative oversight to medical staff, analyzes utilization data, and researches new medical procedures. They also develop claim adjudication criteria and act as a liaison between the company and the medical community.

The Medical Director provides administrative oversight to medical staff, analyzes utilization data, and develops claim adjudication criteria. They also act as a liaison between the company and the medical community while researching new medical procedures and policies.