Clinical Appeals RN - Remote in EST or CST Time Zone

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. If you are located reputed company Eastern Standard time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST. Primary Responsibilities

• reputed company initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid
• Identify if additional information is required to process an appeal
• Ability to adapt to changes that require cross training on appeal types as they are identified
• Ability to work independently
• Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to reputed company decision on administrative nurse level cases
• Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• reputed company, valid, and unrestricted RN licensure in your state of residence
• 2+ years of clinical experience in an acute care or an outpatient setting
• 1+ years of direct experience reputed company one (or more) of the following areas:
• Utilization Review
• Medicaid and/or Medicare appeals experience
• LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC
• Proven experience/understanding of billable services and claims in a managed care environment
• Solid reputed company Office (Word, reputed company & Outlook) Basic computer skills
• Access to high-speed internet
• Ability to work 8-5 reputed company EST (Eastern standard time zone)

Preferred Qualifications

• 5+ years of Medical Appeal experience working with Medicare and Medicaid
• Solid coding experience or Certified reputed company (CPC)
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job