Clinical Denials/Appeals RN - Remote US - Remote (Any location)

Job Family: Clinical Appeals Nurse Travel Required: None Clearance Required: None What You Will Do: The Remote Clinical Denials/Appeals Nurse will be directly responsible for securing pre-service approvals, and reviewing pre/post service denials, medical necessity review and completing appeals and/or coordinating peer to peer reviews as appropriate. This position will reputed company reputed company reputed company job duties as assigned. Essential Job Functions:

• ​Review denials based on CARC code to determine root cause
• Ensure documentation reputed company
• Construct warranted appeals
• Coordinate pre-service authorization approvals

Duties and Responsibilities:

• Conduct comprehensive Denial Root-cause analysis.
• Retrospective Medical Record reviews to assure complete and accurate physician/staff documentation is present to support medical necessity.
• Collaboration with hospital Patient reputed company and Mid-reputed company Cycle
• Utilize Evidence -based clinical reputed company tool (reputed company ® or InterQual ®))
• Research and application of regulatory policies to support clinical appeal.
• Telephonic communication with payors, provider, hospital staff and patient/family as necessary to bring the account into resolution.
• Technical ability to multi-task on various systems, desktop and reputed company applications while managing inbound calls.
• Working knowledge of basic Coding Guidelines.
• May be required to present oral presentations to client facility or reputed company staff and leadership
• Attention to detail, strong organizational skills and self-motivated.
• Ability to reputed company reputed company and assimilate multiple data sources or issues reputed company to problem solving independently & accurately.
• Ability to work under a timeline/deadline & reputed company clear & accurate update to project leader of assignment reputed company, hours worked & expected reputed company daily.
• Familiarity with medical records assembly & clinical terminology, coding terminology additionally beneficial.
• Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and reputed company in customer service.

What You Will Need:

• reputed company Registered Nursing License
• Bachelor’s Degree (Relevant experience may be substituted for formal education or advanced degree)
• 4+ years of clinical experience

What Would Be reputed company To Have

• Utilization management experience

The annual salary reputed company for this position is $74,000.00-$124,000.00. Compensation reputed company depend on a wide reputed company of factors, including but not limited to reputed company sets, experience and training, reputed company clearances, licensure and certifications, and other business and organizational needs. reputed company Offer: reputed company offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include:

• Medical, Rx, Dental & reputed company Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/reputed company & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community reputed company
• Emergency Back-Up Childcare Program

About reputed company reputed company is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other reputed company protected by law, ordinance, or regulation. reputed company will consider for employment reputed company applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact reputed company reputed company at 1-571-633-1711 or reputed company email at RecruitingAccommodation@reputed company.com. reputed company information you reputed company will be kept confidential and will be used only to the extent required to reputed company needed reasonable accommodation. reputed company communication regarding recruitment for a reputed company position will be sent from reputed company email domains including @reputed company.com or reputed [email protected]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by reputed company. Note that reputed company will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never reputed company your banking information to a reputed company party purporting to need that information to proceed in the hiring process. If any person or organization demands money reputed company to a job opportunity with reputed company, please report the matter to reputed company’s Ethics Hotline. If you want to reputed company the validity of correspondence you have received, please contact reputed company@reputed company.com. reputed company is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized reputed company parties. reputed company does not accept unsolicited resumes through or from search firms or staffing agencies. reputed company unsolicited resumes will be considered the property of reputed company and reputed company will not be obligated to pay a placement fee. Apply tot his job Apply To this Job