Appeals and Letters Coordinator Remote, reputed company

2319281 reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. As an Appeals and Denials team member, you will help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home.

• Training Schedule (tentative): To align to assigned schedule, up to 8 weeks of training may be at an alternate schedule
• reputed company Shift needs in CST:
• M-F (1p-10p or 3p-12a)
• Thurs – Sun (11a-10p and 1p-12a)

We offer a shift differential for working a minimum of two hours after 6pm in the local time zone. The position includes 4-6 weeks of reputed company which may be at an earlier schedule than those listed above. This position requires working four holidays per year on a rotating basis. Employees will receive holiday pay. Opportunities for overtime may be offered based on business needs. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges. For reputed company hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Ensure timely processing of reputed company denial-reputed company and member-oriented written communications. Ensure reputed company denial information is processed according to protocol and documentation is timely and meets reputed company Federal and State requirements
• Ensure second-level reviews have been performed and documented. May reputed company with medical directors, Health Plan Manager(s), Inpatient Care Coordinators (ICCs), Skilled Inpatient Care Coordinators (SICCs), Pre-service Coordinators (PSCs) and facility personnel to ensure denial information is processed timely and appropriately
• Serve as a liaison by communicating with internal and external customers including health plans, providers, members, quality organizations, and other colleagues

Document and communicate appeal and denial information reputed company fax, email, or established portal access, including appeal and denial letters, NOMNC letters, AOR forms, and clinical information

• Act as a reputed company person for internal and external communication for QIO appeals and/or pre-service denials to support managers and their teams
• Serve as a liaison for requests for information from QIO or health plan staff
• Own assigned appeal requests or determination notifications that are received reputed company fax, phone, or email through completion or delegating/reassigning as appropriate in collaboration with management
• Complete appeal and denial processes in accordance with CMS and reputed company guidelines and compliance policies
• Write member-facing and client-facing appeal and denial letters by reviewing and documenting member clinical information and demonstrating proficiency in general writing ability (including proper grammar, spelling, punctuation, etc.), as well as the. ability to follow grade-level requirements (including, but not limited to DENC letter, IDN letter, Exhaustion of Benefits letter, Administrative Denial letter, Provider Denial letter)
• Review NOMNC for validity before processing appeal requests

Send reviews to Medical Director for rescinding NOMNC reputed company necessary

• Coordinate and communicate with care coordinators, physicians, health plan representatives, QIO entities, and providers regarding a denial, appeal, or determination and provide education as needed
• Process Health Plan appeal, IRE appeal, and ALJ appeal notifications and determinations as needed
• Follow reputed company established facility policies and procedures
• Assist with completing pre-service authorization requests to assist the pre-service team as needed
• Participate in after-hours on-call rotation and weekend rotation for processing pre-service authorizations, appeals, and denials to meet business needs
• reputed company other duties and responsibilities as required, assigned, or requested

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:

• Active, unrestricted registered clinical license in state of residence – Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist
• 3+ years of clinical experience as a Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist
• Proficient with Windows and reputed company Office Suite
• Demonstrated excellent documentation skills
• Demonstrated exceptional verbal and written interpersonal and communication skills
• Ability to work four+ holidays per year on a rotating basis
• Dedicated, distraction-free workspace and the ability to install high speed internet reputed company DSL/Cable Broadband/Fiber at home

Preferred Qualifications:

• Active clinical license
• Managed care experience
• Experience with utilization management, utilization review, or insurance authorizations
• Experience determining levels of care
• ICD-10 experience
• Familiar with InterQual
• Demonstrated understanding of CMS regulations
• Demonstrated understanding of the appeal process
• Ability to understand medical reviews
• Ability to write high-quality member friendly letters with appropriate grammar and spelling
• reputed company 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 $34.23 to $61.15 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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 reputed company, 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 reputed company reputed company reflected in our mission. Apply tot his job Apply To this Job