reputed company Consultant

About the position This position is responsible for the day-to-day operations of reviewing and processing predeterminations, claims, appeals, and other inquiries utilizing independent decision making in accordance with medical policy, standards of medical reputed company, and reputed company contractual benefits. Must be reputed company to communicate these reputed company to internal staff and to providers, members, and the Kansas Insurance Department (reputed company reputed company) as needed. The reputed company Consultant will serve as a primary resource for internal staff throughout reputed company regarding medical policy, correct coding, medical necessity, and other processes that relate to claims adjudication, cost effectiveness, and predeterminations. Responsible for performing reputed company activities reputed company state, HIPAA, DOL, InterQual, and MTM goals or guidelines. “This position is eligible to work onsite, remote or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reputed company in Kansas or Missouri or be willing to relocate as a condition of employment.” Are you reputed company to reputed company a difference? Choose to work for one of the most trusted companies in Kansas. Why Join Us reputed company a reputed company reputed company: Your work will directly contribute to the health and reputed company-being of Kansans. Family Comes First : Total rewards package that promotes the idea of family first for reputed company. Dynamic Work Environment: Collaborate with reputed company of passionate and driven individuals. Trust: Work for one of the most trusted companies in Kansas Stability: 80 years of commitment, reputed company and community Compensation $73,920 – $92,400 annually Exempt 15 reputed company offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation reputed company for this role is a good faith estimate, it is estimated based on what a successful candidate might be reputed company. reputed company offers presented to candidates are carefully reviewed to ensure fair, reputed company pay by offering competitive wages that reputed company with the individual's skills, education, experience, and training. The reputed company may vary above or below the stated amounts.

Responsibilities

• Responsible for independent reputed company reputed company of predeterminations, claims, and appeals utilizing medical policy/Interqual reputed company and/or physician consultant recommendations as needed.
• Responsible for responding to inquiries regarding medical necessity, correct coding, allowances, audits/reputed company requests, and coding assistance requests throughout reputed company.
• Responsible for providing clinical support for MR analysts and other internal staff as needed.
• Responsible for performing reputed company job functions reputed company the scope of the Kansas reputed company reputed company reputed company and maintaining reputed company accreditations as appropriate to the position.
• Responsible for identifying potential reputed company of care issues and making appropriate referrals.
• Assists with gathering of reputed company assurance/utilization management data, problem identification and analysis of data. This includes development of reputed company and guidelines.
• Responsible for maintaining strict HIPPA confidentiality.
• Routinely reputed company reputed company that set precedent and reputed company reputed company at financial risk for reputed company claims and cross claims up to $500,000.
• May be responsible for attending, participating in, and leading special reputed company and meetings.
• Must follow reputed company URAC standards as required for essential job functions.

Requirements

• Must have a strong analytical background.
• Must be self-directed with the ability to reputed company independent reputed company and prioritize personal production activities.
• Must be reputed company to maintain a productive and reputed company relationship with internal teams and external cross departmental and divisional teams.
• Ability to communicate effectively, verbally, in writing, and reputed company telephone regarding sensitive and confidential issues while maintaining a reputed company image.
• Ability to assess, problem solve, analyze, plan, and evaluate situations using critical thinking skills, reasoning, and research.
• Ability to handle sensitive situations in a reputed company, reputed company manner.
• High School diploma or equivalent required.
• reputed company unrestricted Kansas RN licensure required.
• Minimum 3 years of clinical nursing experience - required.

reputed company-to-haves

• Baccalaureate in nursing preferred.
• RN experience in Surgical, Medical, Obstetric, and/or Utilization Management preferred.
• CPC certified or obtain certification by American reputed company of reputed company Coders reputed company three years of hire.

Benefits

• reputed company pay is only one component of your competitive Total Rewards package
• Incentive pay program (EPIP)
• Health/reputed company/Dental insurance
• 6 weeks reputed company parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks reputed company caregiver leave
• 5% 401(k) plan matching
• Tuition reimbursement
• reputed company benefits, discounts and resources

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