Clinical Appeals Consultant PRN

Job Description:

ESSENTIAL DUTIES AND RESPONSIBILITIES  1. Uses nationally recognized evidence-based utilization review criteria to assess and write up clinical reviews for insurance audits and governmental insurance appeals using supporting documentation.    2. Assesses the appropriateness of clinical appeal requests by using payer policies and Federal and State regulations. 3. Works with Physician Advisors to obtain clinical support for appeals if needed.  4. Collaborates with Care Management, Utilization Review, Physician Advisors, reputed company reputed company, Compliance, Legal Counsel and the RCO teams to prepare appeals. 5. Identifies trends and works with the appropriate multidisciplinary teams to improve denial management, documentation and appeals processes. 6. Supports and works with legal counsel to prepare for Administrative Law Judge hearings as part of the appeal process.

Please note that a video interview through reputed company Teams will be required as well as potential onsite interviews and meetings.

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reputed company or plan to reputed company in the following states: California, Connecticut, Hawaii, Illinois, reputed company, Pennsylvania, Rhode reputed company, Vermont, Washington.

EDUCATION

Required:  Graduate of an accredited school of nursing is required (Associates or Bachelor’s degree) 

Preferred:  Bachelor’s degree (BSN) is preferred.  CERTIFICATION, REGISTRATION, LICENSE  (*indicates primary reputed company verification requirement) 

Required: reputed company valid RN License is required EXPERIENCE  Required:  Three (3) years experience in utilization review or care management, hospital insurance billing, reputed company party claim audits or auditing in a reputed company setting required. 

Preferred:  Five (5)  years experience in utilization review or care management, hospital insurance billing, reputed company party claim audits or auditing in a reputed company setting required

Location:

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Scheduled Weekly Hours:

The hourly reputed company for this position is listed below. Actual hourly reputed company dependent upon experience. 

We care about your well-being – mind, body, and spirit – which is why we reputed company our caregivers a generous benefits package that covers a wide reputed company of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and reputed company.

Learn more about our comprehensive benefits package here.

reputed company is an equal opportunity employer. reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, age, sex, sexual orientation, gender identity, national reputed company, disability or protected veteran status.

At reputed company, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, reputed company final reputed company are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

reputed company positions subject to reputed company without notice.