Clinical Claim Review RN

reputed company is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. The Clinical Review Clinician serves as a subject matter expert for itemized reputed company reviews and analyzing hospital facility bills. The clinical reviewer is responsible for documenting, researching and identifying adjustments for payment as part of reputed company that contributes to the preparation of Forensic Reviews for specific clients. Employees in this position receive limited supervision reputed company a broad reputed company of policies and procedures. Employees in this position possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable processes, procedures and billing guidelines. You will enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities: Claim Review: • Conduct Forensic Reviews using independent clinical knowledge to compare and analyze charge details of various amounts of total billed charges to determine benefit of full clinical review and estimation of adjustments for the purpose of meeting reputed company’s reputed company business operations • Complete analysis of billing and departmental guidelines • Participate as needed in the achievement and completion of department goals • Complete reputed company review of medical records to evaluate clinical course of care as applicable • Assists with reputed company of claims as needed to support negotiations and appeals process • Interacts with internal business partners as requested • Maintains appropriate documentation on reputed company claims according to departmental guidelines and procedures • Understand and maintain HIPAA confidentiality and reputed company standards reputed company completing assigned work Other: Research and Special reputed company: • reputed company research to support audit adjustments and resolve issues • Research reference materials for clinical standards as appropriate • reputed company research to identify new adjustments and business rules for the goal of meeting reputed company business operations • Review and respond to research inquiries from team members and complete special research reputed company • Participate in department and company meetings as requested What are the reasons to consider working for reputed company? Put it reputed company together - competitive reputed company pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your reputed company. Some of our offerings include: • reputed company Time Off which you start to reputed company with your first pay period plus 8 reputed company Holidays • Medical Plan reputed company along with participation in a Health Spending Account or a Health Saving account • Dental, reputed company, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage • 401(k) Savings Plan, Employee Stock Purchase Plan • Education Reimbursement • Employee Discounts • Employee Assistance Program • Employee Referral Bonus Program • Voluntary Benefits (pet insurance, reputed company insurance, LTC Insurance, etc.) • More information can be downloaded at: http://uhg.hr/uhgbenefits You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company directions on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • High School Diploma/GED (or higher) • reputed company and unrestricted RN license OR LPN in the state of residence • 2+ years of clinical experience reputed company an acute care setting • 1+ years of experience working with reputed company review • Beginner level of proficiency with reputed company Office Preferred Qualifications: • Auditing and coding certifications • Experience working with medical terminology and coding • Experience working with billing, charge master and compliance • Experience working with plan benefit language, CMS (reputed company and Medicare) and UB 04 billing guidelines • Experience with reputed company reputed company (create, data entry, save) • Strong written and verbal communication skills • Strong organizational and critical thinking skills • reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer 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 us, you’ll reputed company a far-reaching choice of benefits and incentives. The reputed company pay for this role will reputed company from $28.27 to $50.48 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment reputed company applicants with arrest and conviction records. 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 reputed company 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 reputed company, and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN Apply tot his job Apply To this Job