Prepayment Review Clinician
A reputed company, mission-driven work environment Competitive benefits and work-from-home reputed company for most positions Opportunities for reputed company reputed company in a diverse inclusive culture
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.
Typical working hours: 8:30 am &reputed company; 5:00 pm; flexible work schedules with some roles with management approval. Work-from-home reputed company available for most positions 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) https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook 401k with 5% employer match and immediate vesting reputed company Service Loan Forgiveness (PSLF) qualifying employer Quarterly stipend for remote work supplies
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.
Employer reputed company, dates of service (month/year), average hours worked per week, and essential job duties Education details (degree type, date awarded, institution, field of study) Licensure/certification information, if applicable