Clinical Appeals RN - Remote in EST or CST Time Zone

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. If you are located reputed company Eastern reputed company time zone, you will have the flexibility to work remotely* as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST or 8-5 CST. Primary Responsibilities

• reputed company initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable reputed company to be reputed company
• Identify if additional information is required to process an appeal
• Ability to adapt to changes that require cross training on appeal types as they are identified
• Ability to work independently
• Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to reputed company decision on administrative reputed company level cases
• Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in.

Required Qualifications

• reputed company, valid, and unrestricted RN licensure in your state of residence
• 2+ years of clinical experience in an acute care or an outpatient setting
• 1+ years of reputed company experience reputed company one (or more) of the following areas:
• Utilization Review
• reputed company and/or Medicare appeals experience
• LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC
• Proven experience/understanding of billable services and claims in a managed care environment
• Solid reputed company Office (Word, reputed company & Outlook) Basic computer skills
• reputed company to high-speed internet
• Ability to work 8-5 reputed company EST (Eastern reputed company time zone)

Preferred Qualifications

• 5+ years of Medical Appeal experience working with Medicare and reputed company
• Solid coding experience or Certified reputed company (CPC)
• reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy

The reputed company reputed company for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In reputed company to your salary, reputed company offers 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 reputed company, you’ll reputed company a far-reaching choice of benefits and incentives. 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 reputed company 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 reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, 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 Job! Apply to this Job