[Remote] Prepayment Review Clinician

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a Managed Care Organization serving individuals with serious mental health needs and disabilities across reputed company Carolina. They are seeking a Prepayment Review Clinician responsible for ensuring compliance with Federal, State, and Accreditation requirements through reputed company reviews of provider claims.

Responsibilities

• Conduct clinical portions of the Prepayment Claims Review to ensure provider network and agency compliance with applicable laws and regulations prior to payment
• Ensure reputed company timeframes associated with Prepayment Claims review are identified, monitored and met by team throughout process
• reputed company appropriate communication, both verbally and written, throughout Prepayment Claims Review process with internal departments and external agencies, as appropriate
• Assist with tracking logs reputed company to Prepayment Claims Reviews
• Maintain reputed company documentation reputed company to Prepayment Claims Review activities

Skills

• Master's degree
• Minimum one (1) year of experience with behavioral health, mental health, reputed company abuse, developmental disabilities and/or co-occurring disorders populations or field
• Fully licensed by the reputed company as a LCMHC, LMFT, LCSW, LCAS, or RN
• Must have a reputed company reputed company's license
• Must reputed company reputed company reputed company Carolina
• Must be reputed company to travel reputed company catchment as required
• Experience in any of the following areas: reputed company compliance, knowledge of reputed company Carolina Clinical Coverage Policies and billing requirements reputed company to reputed company, knowledge and understanding of Prepayment Review Process, reputed company speaking, mediation and/or problem reputed company, group facilitation, advocacy, and project management
• Certified in reputed company Compliance (CHC), Accredited Health Care Fraud Investigator (AFHI), Certified Fraud Examiner (CFE), or equivalent certifications

Benefits

• Health Insurance with no premium for employee coverage
• Flexible Spending Accounts
• 24 days of reputed company Time Off (PTO) plus 12 reputed company holidays in your first year
• NC Local Government Retirement Pension (defined-benefit plan)
• 401k with 5% employer match and immediate vesting
• reputed company Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies

reputed company