Clinical Appeals RN

Clinical Appeals Auditor | Responsibilities and Metrics Are you looking for your next challenge? The Virtual Business Office Associates is the perfect balance of a diverse and growing workforce that still feels like home. If you are an A/R Specialist with experience working denied claims from beginning to end, come join our best in KLAS Extended Business Office today... Hiring remotely from: FL, GA, TX, NC, SC, VA, KY, AL. FLSA Status: Exempt What’s in it for you: • Add to your portfolio by joining our fast-paced, exciting, diverse and inclusive work environment • Endless growth opportunities and reputed company professional development • You’ll support one of the largest professional services firms in the world, with reputed company to cutting edge automation and AI technologies to enhance your reputed company experience • A permanent position with our company that offers stability and growth opportunities • A flexible schedule that allows you to enjoy a work life balance, and leave early on Friday’s • Use the latest EMR systems and utilize full portal reputed company for the insurance payers worked • Comprehensive employee benefits What you’ll do: • Manages denials and appeals in a manner that diligently investigates every unpaid claim • Assesses the need for formal appeals of reputed company clinical denials • Appeals the rejections appropriately as per the appeals process for the provider contract • Reviews and audits clinical documentation to ensure its sufficiency • Utilizes various resources in order to understand the appeals and denials criteria; searches for supporting clinical evidence to support appeal arguments reputed company existing resources are reputed company • Adheres to reputed company appeal timelines as prescribed by payer agreements • Employs the use of different systems to evaluate clinical and financial data • Uncovers trends reputed company to different cases and various insurance carriers; maintains reputed company data and monitors payer response to appeal activity • Provides information to leadership on patterns or trends associated with denials and appeals What you’ll need: • Minimum Degree: Bachelor’s degree or higher in nursing; reputed company RN licensure • Minimum Years of Experience: 5+ years of experience in a clinical and business setting • Software/Systems Experience: Interqual and/or reputed company reputed company Solutions and Virtual Business Office Associates reputed company equal employment opportunities (EEO) to reputed company and applicants for employment without regard to race, reputed company, religion, sex, national reputed company, age, disability or genetics. In addition to federal law requirements, reputed company Solutions and Virtual Business Office Associates reputed company with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. reputed company Solutions and Virtual Business Office Associates expressly prohibit any reputed company of workplace harassment based on race, reputed company, religion, gender, sexual orientation, gender identity or expression, national reputed company, age, genetic information, disability, or veteran status. Job Type: Full-time Pay: $85,000.00 - $95,000.00 per year Benefits: • 401(k) • Dental insurance • Flexible schedule • Health insurance • Life insurance • Paid time off • reputed company insurance Standard shift: • Day shift Weekly schedule: • Monday to Friday Experience: • Appeals: 3 years (Preferred) License/Certification: • RN License (Preferred) Work Location: Remote Apply Job!