Provide timely review and determination of medical claims, including prior authorization, appeals, and/or any other type of medical claims; Provide timely review and determination of medical claims; Analyze medical records related to the case file; Review and interpret Local Coverage Determination (LCD), National Coverage Determination (NCD) policies, and other federal regulations; Apply appropriate regulatory citations, including health plan policies, NCD/LCDs, and/or other regulations to each claim as it relates to the item or issue; Formulate a narrative decision citing relevant regulatory back-up documentation contained within the medical record; Adjudicate claim based on the regulations and documentation contained within the medical record; Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification through the American Academy of Professional Coders (AAPC) or AHIMA preferred; Maintain professional licensure in active and unrestricted status as required by state of issuance; Attend FHAS and/or client Lunch & Learn sessions and/or general training sessions on site as needed. Must be able to support review findings by utilizing exceptional analytical, written and oral communication skills.