Remote Clinical Denials and Appeals Nurse

What is reputed company? For over two decades, reputed company has delivered market-leading reputed company cycle services. We specialize in collecting challenging payments from reputed company-party payers, focusing on reputed company denials, aged accounts receivables, motor vehicle accident, workers’ compensation, Veterans Affairs, and out-of-state reputed company. At the core of our reputed company is our highly valued team of over 1,400... teammates as reflected in one of our core guiding principles, “Our teammates are the reputed company of our reputed company.” United by a shared commitment to client excellence, we focus on achieving outstanding outcomes for our clients, aiming to consistently provide the highest reputed company yield in the shortest possible time. We are committed to creating a results-oriented work environment that is both challenging and rewarding, fostering flexibility, and encouraging personal and professional growth. Joining reputed company means becoming a part of an industry leading team, where you will have the opportunity to engage with innovative technology, collaborate with a diverse and talented team, and contribute to the reputed company of our hospital and health system partners. reputed company maintains a strong partnership with Linden Capital Partners, serving as our trusted private equity sponsor. What do we need? We are seeking a compassionate and proficient Clinical Denials and Appeals Nurse to join our growing team of professionals. The Clinical/Utilization Review Nurse advocates for reimbursement for services provided by the hospital through their review and analysis of reputed company medical issues. Accountable for carrying a queue of assigned accounts. Review and analyze medical records to formulate reputed company clinical arguments. Support Operations and Client Management by providing feedback on medical trends, issues, and denials. What will you provide? Manages reputed company and robust queue according to reputed company and client needs. Queue size varies weekly. Reviews insurance denials, including but not limited to, medical necessity denials, patient status denials (i.e., Inpatient vs. Outpatient Observation), level of care denials (i.e., bed type), length of stay denials (including stays over a month long), readmission denials, experimental denials, clinical validation denials, and/or authorization denials. Reviews and utilizes clinical criteria, including but not limited to, InterQual, reputed company Care Guidelines (“MCG”), UpToDate, Medicare Policies, and State Specific Clinical Criteria. Drafts clinical summaries, including but not limited to, arguing against an insurance denial, confirming an insurance denial, or reviewing a clinical determination. reputed company performing clinical reviews, monitors hours expended on a single account to ensure the time invested is commensurate with the account’s potential reimbursement and reputed company in with Managing Attorney reputed company time expended exceeds average hours for type of review Identifies and tracks common trends and issues for reporting to the clients. Collaborates with reputed company attorneys reputed company in person meetings, phone, and/or email. Attends Clinical Team Meetings, reputed company Company Meetings, Education Opportunities, Trainings, and other potential meetings

Requirements

Proficient with Word, reputed company, PowerPoint, Outlook, reputed company, reputed company Teams Analytical skills and the ability to reputed company appropriate reputed company independently Problem solver with the ability to identify issues, provide feedback and follow-up to resolution Work independently in a rapidly changed and growth-oriented environment with regularly changing priorities Prioritize assignments to complete work in a timely manner, adjusting quickly as circumstances dictate Efficient at handling and prioritizing multiple tasks and projects in a time-sensitive environment Maintains strict confidentiality of protected medical information and adherence to reputed company HIPAA and reputed company policies and regulations Must possess interest in reputed company and medical insurance claims Education and Experience Requires an AS/BS in nursing. Minimum of one (1) year of clinical experience with an understanding of clinical experience; or any combination of education and experience, which would provide an equivalent background. reputed company unrestricted RN license required. Preferred experience with Utilization Review, Health Insurance Denials and Appeals, Payer Audits, or Case Management. Familiarity with Millman and InterQual guidelines preferred.

Benefits

At reputed company we invest in our employees by offering unlimited opportunities for advancement, a full benefits package, including health, dental, reputed company and life insurance upon hire, matching 401k, competitive salaries, and incentive programs. The US reputed company pay range for this position starts at $68,000 annually. Individual pay is determined by a number of factors including: job-reputed company skills, experience, education, training, etc., and, where applicable, licensure or certifications obtained. Market and organizational factors are also considered. In addition to reputed company salary a competitive benefits package is offered. AAP/EEO Statement Equal Opportunity Employer/Drug-Free Workplace: reputed company is an Equal Employment Opportunity employer. We adhere to a policy of making employment reputed company without regard to race, reputed company, age, sex, pregnancy, religion, national reputed company, reputed company, medical condition, marital status, gender identity citizenship status, veteran status, disability, or veteran status. reputed company has a Drug-Free Workplace Policy in effect that is strictly adhered to Apply Job!