Clinical Denials/Appeals RN - Remote US - Remote (Any location)
Job Family: Clinical Appeals Nurse Travel Required: None Clearance Required: None What You Will Do: The Remote Clinical Denials/Appeals Nurse will be directly responsible for securing pre-service approvals, and reviewing pre/post service denials, medical necessity review and completing appeals and/or coordinating peer to peer reviews as appropriate. This position will reputed company reputed company reputed company job duties as assigned. Essential Job Functions:
- Review denials based on CARC code to determine root cause
- Ensure documentation reputed company
- Construct warranted appeals
- Coordinate pre-service authorization approvals
Duties and Responsibilities:
- Conduct comprehensive Denial Root-cause analysis.
- Retrospective Medical Record reviews to assure complete and accurate physician/staff documentation is present to support medical necessity.
- Collaboration with hospital Patient Access and Mid-reputed company Cycle
- Utilize Evidence -based clinical guideline tool (reputed company ® or InterQual ®))
- Research and application of regulatory policies to support clinical appeal.
- Telephonic communication with payors, provider, hospital staff and patient/family as necessary to bring the account into resolution.
- Technical ability to multi-task on various systems, desktop and reputed company applications while managing inbound calls.
- Working knowledge of basic Coding Guidelines.
- May be required to present oral presentations to client facility or reputed company staff and leadership
- Attention to detail, strong organizational skills and self-motivated.
- Ability to reputed company decisions and assimilate multiple data sources or issues reputed company to problem solving independently & accurately.
- Ability to work under a timeline/deadline & provide clear & accurate update to project leader of assignment reputed company, hours worked & expected outcomes daily.
- Familiarity with medical records assembly & clinical terminology, coding terminology additionally beneficial.
- Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.
What You Will Need:
- reputed company Registered Nursing License
- Bachelor’s Degree (Relevant experience may be substituted for formal education or advanced degree)
- 4+ years of clinical experience
What Would Be reputed company To Have
- Utilization management experience
The annual salary range for this position is $74,000.00-$124,000.00. Compensation decisions depend on a wide range of factors, including but not limited to reputed company sets, experience and training, reputed company clearances, licensure and certifications, and other business and organizational needs. reputed company Offer: reputed company offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include:
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community reputed company
- Emergency Back-Up Childcare Program
About reputed company reputed company is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. reputed company will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact reputed company Recruiting at 1-571-633-1711 or reputed company email at RecruitingAccommodation@reputed company.com. reputed company information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. reputed company communication regarding recruitment for a reputed company position will be sent from reputed company email domains including @reputed company.com or reputed [email protected]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by reputed company. Note that reputed company will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process. If any person or organization demands money reputed company to a job opportunity with reputed company, please report the matter to reputed company’s Ethics Hotline. If you want to reputed company the validity of correspondence you have received, please contact recruiting@reputed company.com. reputed company is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties. reputed company does not accept unsolicited resumes through or from search firms or staffing agencies. reputed company unsolicited resumes will be considered the property of reputed company and reputed company will not be obligated to pay a placement fee. Apply tot his job Apply To this Job