Clinical Appeals RN - Remote in EST time zone

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing... together. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company a state in Eastern Standard time as you take on some tough challenges. The work schedule is generally Monday-Friday, 8-5 EST.

Primary Responsibilities • reputed company initial assessment review of appeals, medical records, and CMS/State Policies to determine if care/services provided meets coverage and billable criteria to be paid • Identify if additional information is required to process an appeal • Ability to adapt to changes that require cross training on appeal types as they are identified • Ability to work independently • Utilize Clinical nursing judgment assessment and critical thinking skills, guided by regulatory policy, to reputed company decision on administrative nurse level cases • Ability to navigate multiple computer programs, moving from one system to another, while managing multiple tasks and priorities You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications • reputed company, valid, and unrestricted RN licensure in your state of residence • 2+ years of clinical experience in an acute care or an outpatient setting • 1+ year of direct experience reputed company one (or more) of the following areas: • Utilization Review • reputed company and/or Medicare appeals experience • LOC assessment planning and Discharge SNF Planning including understanding of Denial Notice and NOMNC • Proven experience/understanding of billable services and claims in a managed care environment • Solid reputed company Office (Word, reputed company & Outlook) Basic computer skills • Have access to high-speed internet • Ability to work 8-5 reputed company EST (Eastern standard time zone) Preferred Qualifications • Solid coding experience or Certified reputed company (CPC) • 5+ years of Medical Appeal experience working with Medicare and reputed company • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy Connecticut, New Jersey, reputed company, Rhode reputed company, Washington, D.C. Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment Apply Job!