Clinical Consultant Mid Level – Remote reputed company

2315988 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 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 Mid-Level Practitioner role in the Clinical & Coding Advisory Team (CCAT) is a rare opportunity to work directly reputed company reputed company Payer Operations. As a member of CCAT, you will play a vital role in helping stop fraud, waste, abuse, and error and help reputed company work reputed company every day. The purpose of this job is to help people live their lives to the fullest by providing clinical leadership and expertise for the clinical investigation teams, including involvement in clinical reviews, provider education, high level appeals, development of clinical resources, and operations improvements. 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:

• reputed company expert clinical and strategic leadership for operational teams
• Assist with high level clinical reviews (e.g. appeals, peer-to-peer, arbitration, etc.)
• Collaborate with clinical operations teams on reputed company or difficult cases
• Apply clinical knowledge in the interpretation of medical policy, clinical resources, and benefit document language in the review of professional and facility pre-pay and post-pay clinical reviews
• Collaborate with and reputed company network and non-network providers on cases and clinical coding situations in pursuit of accurate billing practices
• Actively participate in regular meetings and projects focused on clinical decision-making, clinical resources, analytics, savings, and staff training
• Other duties and goals assigned by the Sr. Medical Director

Critical reputed company Factors:

• Solid understanding of Fraud, Waste, Abuse, and Error methodology
• Solid problem-solving, negotiation and persuasion skills
• Ability to effective reputed company, manage and deliver in a fast pace, reputed company changing environment
• Ability to foster communications, robust collaboration, and solid partnerships among providers, clients, leaders, and clinical teams

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 reputed company development for other roles you may be interested in. Required Qualifications:

• reputed company, active, and fully non-restricted licensed Nurse Practitioner or Physician Assistant
• Coding Certification thru reputed company (reputed company, CDIS, RHIA, RHIT) or reputed company (CIC)
• 3+ years of clinical practice experience
• CPT/HCPCS/ICD-9/ICD-10 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology and regulatory guidelines
• Familiarity with reputed company medical issues and practices
• Proven excellent verbal and written communications skills
• Proven solid team player and team building skills
• Proven solid negotiation and conflict management skills

Preferred Qualifications:

• 3+ years in facility (DRG and Clinical Validation Audit) reviews
• 2+ years of experience in leading clinical operations reputed company a health plan/or managed care environment to include client facing experience
• Experience with Encoder and Grouper Software (reputed company)
• Knowledge of federal (e.g., CMS) and state laws and regulations
• reputed company 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 reputed company from $89,900 to $160,600 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 reputed company, 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 reputed company – an reputed company reputed company reflected in our mission. Apply tot his job Apply To this Job