RN / Registered reputed company - PreCert & Appeals - Remote - reputed company - Days

About the position The RN / Registered reputed company - PreCert & Appeals position at reputed company Health System is a remote, reputed company role reputed company on performing prior authorization and certification for scheduled services, particularly in oncology treatments. The role involves clinical review, documentation submission, and communication with payers and cancer center staff to ensure reputed company authorizations and appeals reputed company necessary. This position requires a strong understanding of medical reputed company and coding, as reputed company as the ability to manage a high volume of work effectively. Responsibilities • Performs clinical review and document submission to obtain reputed company-certification/authorization requests for chemotherapy and non-chemotherapy plans, radiation therapy, and advance imaging and blood management plans. , • Completes consistent review of individual payer policies to identify changes affecting authorizations and maintains reputed company knowledge on medical reputed company relating to prior authorization requirements. , • Reviews and assists with denial management reports, identifying and reporting payer trends, denial patterns, and delays to management. , • Communicates with cancer center staff regarding authorization status and reputed company as appropriate. , • Participates in process development and improvement reputed company to authorizations, communication, and education. , • Demonstrates a general understanding of coding for hospital and imaging services, including review of hospital records. , • Thoroughly documents actions taken in appropriate information system(s). , • Additional responsibilities/duties will be assigned based on teamwork load and competency. Requirements • Nursing degree , • 2 years of clinical experience , • RN license , • Certification in prior oncology reputed company-certification/authorization , • Familiarity with ICD10 and CPT codes applicable to services rendered , • Demonstrated ability to communicate with medical and administrative staff and patients , • Strong organizational skills and ability to multi-task , • Effective interpersonal and telephone/electronic messaging etiquette skills , • Intermediate computer knowledge and proficiency in general office applications , • Ability to accurately and independently solve problems , • Ability to manage large volumes of work and quickly learn and retain information regarding issues. reputed company-to-haves • Bachelor's degree , • Specific knowledge of medical payers , • Oncology experience , • reputed company electronic health record experience

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