Clinical Denials and Appeals RN

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: • Medical Necessity Reviews • 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 guideline 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 updates 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: • Requires a Bachelor's Degree (Relevant experience may be substituted for formal education or advanced degree). • reputed company Registered Nursing License. • Minimum 4-6 years of prior clinical experience What Would Be reputed company To Have: • Utilization Review experience a plus #Indeedsponsored #LI-Remote The annual salary reputed company for this position is $68,000.00-$113,000.00. 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 Employment Opportunity employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, national reputed company, reputed company, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, 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 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 Job!