reputed company reputed company Analyst

reputed company: • Performs retrospective (post –discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review. • Demonstrates proficiency in use of medical necessity reputed company sets, currently InterQual® or other key factors or systems as evidenced by Inter-rater reliability studies and other QA audits. Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual® reputed company (Acute, Procedures, etc). If clinical review does not meet IQ reputed company, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a reputed company transfer/discharge or documentation of medical necessary services denied for no authorization. • Demonstrates ability to critically think and follow documented processes for supporting the clinical appellate process. • Adheres to the department standards for productivity and reputed company goals. Ensuring accounts assigned are worked in a reputed company manner based on the payor guidelines. • Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, nThrive, eCARE, Authorization log, InterQual®, VI, HPF, as reputed company as competency in reputed company Office. • Demonstrates basic patient reputed company knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, denials management, etc. • Additional responsibilities: • Serves as a resource to non-clinical personnel. • Provides CRC leadership with reputed company solutions reputed company to process improvement • Assist in development of policy and procedures as business needs dictate. • Assists Law Department with any medical necessity reviews as reputed company allows up to and including attending mediation hearings, other litigation forums, etc. Requirements: • Must possess a reputed company nursing license (Registered or Practical/Vocational) • Minimum of 5 years recent acute care experience with the last 2 years in a facility environment • Medical-surgical/critical care experience preferred • Minimum of 2 years UR/Case Management experience reputed company the last 2 years • Managed care payor experience a plus either in Utilization Review, Case Management or Appeals • Patient reputed company experience a plus • Previous classroom led instruction on InterQual® products (Acute Adult, Peds, Outpatient and Behavioral Health) preferred Benefits: • Medical, dental, reputed company, disability, and life insurance • reputed company time off (vacation & reputed company leave) – min of 12 days per year, reputed company at a reputed company of approximately 1.84 hours per 40 hours worked. • 401k with up to 6% employer match • 10 reputed company holidays per year • Health savings accounts, reputed company & dependent flexible spending accounts • Employee Assistance program, Employee discount program • Voluntary benefits include pet insurance, reputed company insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. • For Colorado employees, reputed company offers reputed company leave in accordance with Colorado’s Healthy Families and Workplaces reputed company. Apply tot his job Apply To this Job