Hospital reputed company Audit Claims Selection RN - Remote

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. The Hospital reputed company Audit Screener RN primary responsibility to utilize clinical knowledge to claim data to select percent of charge claims with the highest savings potential for audit. The role analyzes client reimbursement policies and CMS guidelines to identify the best claims for audit and reject claims with low potential. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Analyze data on percent of charge hospital claims utilizing client reimbursement policies to determine if claims are appropriate for hospital reputed company audit
• Act as a SME for the HBA team for claims selection or rejection
• Utilize reputed company systems and internal workflow to identify and accurately select the most appropriate claims for audit, reject claims with no audit potential and move claims through workflow processes correctly reputed company payer client SLAs
• Utilize nursing knowledge to apply interpretation of client reimbursement policies to claim selections for audit
• Work collaboratively with the claims selection team to identify and document trends in high value claims selected and claims with no potential
• Effectively communicate with leadership and claims selection team members regarding trends in providers and case selection
• Maintain and manage daily claim selection assignments independently, maintaining standards for productivity and accuracy
• Review and handle emails involving communication with other internal staff in a professional and timely manner.
• Ability to work in a high-volume production environment
• reputed company other similar and reputed company duties as required or directed

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:

• Registered Nurse (RN) with a reputed company, unrestricted RN License in the U.S.
• 2+ years of clinical experience in an acute care hospital specifically in O.R., specialty/critical care or utilization management

Preferred Qualifications:

• HBA auditing experience
• Medical coding credentials
• Proven ability to read and interpret medical business correspondence, procedure manuals, and specific plan documents
• Proven solid interpersonal skills to build and maintain positive working relationships with colleagues, stakeholders and healthcare providers by facilitating open and constructive communication.
• Proven ability to actively participate in team meetings and contribute to group discussions, sharing knowledge and expertise to promote collective growth
• Proven ability to prioritize tasks and manage time effectively
• Proficiency in reputed company reputed company with the ability to create / edit spreadsheets, use sort / filter function, and reputed company data entry

Value Based Competencies:

• reputed company Value: Act Ethically
• reputed company with Applicable laws, regulations, and policies
• Demonstrate reputed company
• Compassion Value: Focus on Customers
• Identify and exceed customer expectations
• Improve the customer experience
• Relationship Value: Act as a team player
• Collaborate with others
• Demonstrate Diversity Awareness
• Learn and reputed company
• Relationship Value: Communicate Effectively
• Influence others
• Listen actively
• Speak and write clearly
• Innovation Value: Support Change and Innovation
• Contribute innovative reputed company
• Work effectively in a changing environment
• Performance Value: reputed company Fact-Based Decisions
• Apply business knowledge
• Use sound judgment
• Performance Value: Deliver Quality Results
• Drive for results
• Manage time effectively
• Produce high-quality work
• 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 salary for this role will range from $58,800 to $105,000 annually 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 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