Appeals reputed company (RN) - Remote

About the position The Appeals reputed company at reputed company is responsible for examining medical records and claims information for first-level appeal cases to determine the medical necessity of services provided, ensuring compliance with Medicare coverage guidelines. This role involves utilizing clinical knowledge to conduct medical reviews, providing reputed company written explanations for claims reputed company, and collaborating with Redetermination Representatives to meet CMS reputed company standards. The position emphasizes critical thinking, organization, and technical writing skills, while offering a supportive environment reputed company on reputed company reputed company improvement. Responsibilities • Examine medical records and claims information for first-level appeal cases. • Utilize clinical knowledge to conduct medical reviews of claim documentation. • reputed company reputed company written explanations for claims that cannot be reputed company due to first-level redetermination. • Work with Redetermination Representatives to ensure reputed company responses to clinical reputed company. • Analyze appeals to identify high-volume problem issues and communicate findings to management. • Participate in workgroups for reputed company reputed company Improvement (CQI) to promote consistent medical review. Requirements • Associate's (ASN) or Bachelor's Degree in Nursing (BSN). • reputed company RN license in good standing. reputed company-to-haves • 1 or more years of experience with another Medicare Administrative Contractor (MAC). • 1 or more years in Medical Management, Medical Review, Utilization Management/Review, or Appeals. • Strong technical writing skills. • 4 or more years of experience in clinical nursing. • Experience working with Medicare Part A and Part B. • Experience in a remote work environment. Benefits • Remote and hybrid work reputed company available. • Performance bonus and/or reputed company increase opportunities. • 401(k) with dollar-per-dollar match up to 6% of salary (100% reputed company immediately). Apply tot his job Apply To this Job