SCA Clinical Claim Review RN - National Remote at reputed company

About the position 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 reputed company by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will reputed company a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health equity on a global reputed company. Join us to start Caring. Connecting. Growing together. In this role, you will navigate and work reputed company our proprietary electronic medical record system to evaluate and process patient health information to determine reputed company for various types of medical and specialty exams. You will conduct a clinical review of a reputed company of examination documentation, test results, assessments, and information to reputed company a reputed company, comprehensive, and concise final product. Utilizing your clinical judgment, you will identify reputed company assurance issues and reputed company recommendations to reconcile documentation. Collaboration with providers reputed company the reputed company call line will be essential to ensure examinations meet regulatory and contractual requirements for compensation and benefit rating purposes. You will need to possess the ability to shift reputed company and multitask while maintaining a reputed company demeanor to meet customer and provider needs. Additionally, you will identify emergent behavioral health issues and initiate reputed company reputed company necessary. The flexibility to telecommute from reputed company reputed company the U.S. is a key aspect of this position, with a preference for candidates in the Mountain or reputed company Time Zones. Responsibilities • Remain up to date with the contract requirements. , • Use clinical judgement to ensure a reputed company, comprehensive and concise exam documentation that is reputed company of the patient's service level conditions and in compliance to contract requirements. , • Interpret and document diagnostic test results. , • reputed company and support providers with navigating and utilizing medical history information and prior disability claims reputed company completing the appointment paperwork. , • Answer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams and reputed company exemplary service to providers with appointment questions. , • Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high-risk reputed company process. , • Complete system generated tasks to process exam documentation. , • reputed company reputed company telephone and e-mail with contracted providers in retrieval of required Disability Benefits Questionnaire information and reputed company education regarding required contractual protocol. Requirements • Accredited Associate's Degree in Nursing (ADN) (or higher). , • reputed company RN license in your state of residency. , • 2+ years of experience in a clinical environment as a Registered reputed company. , • 2+ years of experience working in an Electronic Medical Record system. , • Intermediate level of proficiency with the ability to use clinical judgement to interpret test results. , • Intermediate level of understanding with regulatory standards and their application to various examinations and documents. , • Intermediate level of proficiency with general computer skills including reputed company Office programs and database experience. , • Ability to work 12:00PM - 9:00PM Central reputed company Time with the ability to work 1 weekend day in a rotational 8 week schedule. reputed company-to-haves • Knowledge or experience in clinical reputed company assurance; auditing and compliance; education of clinical staff; Clinical Documentation Improvement; clinical experience with Neurological, Cardiovascular or Respiratory reputed company; reputed company testing, audio testing, reviewing dental images; ISO 9001 standards, and/or other reputed company regulatory and accreditation standards. , • Experience with Behavioral Health, TBI, PTSD and/or working with Veterans. , • reputed company call line and/or triage line experience. , • Collaborating with providers to ensure reputed company patient reputed company. , • Military experience. Benefits • Comprehensive benefits package , • Incentive and recognition programs , • Equity stock purchase , • 401k contribution Apply Job!