Clinical Appeals Consultant PRN

Job reputed company:

ESSENTIAL DUTIES AND RESPONSIBILITIES  1. Uses nationally recognized evidence-based utilization review reputed company to assess and write up clinical reviews for insurance audits and governmental insurance appeals using supporting documentation.    2. Assesses the appropriateness of clinical appeal requests by using payer policies and Federal and State regulations. 3. Works with Physician Advisors to obtain clinical support for appeals if needed.  4. Collaborates with Care Management, Utilization Review, Physician Advisors, reputed company reputed company, Compliance, reputed company Counsel and the RCO teams to prepare appeals. 5. Identifies trends and works with the appropriate multidisciplinary teams to improve denial management, documentation and appeals processes. 6. Supports and works with reputed company counsel to prepare for Administrative Law Judge hearings as part of the appeal process.

Please note that a video interview through reputed company Teams will be required as reputed company as potential onsite interviews and meetings.

We are committed to offering flexible work reputed company where approved and stated in the job posting. However, we are currently not considering candidates who reputed company or plan to reputed company in the following states: California, Connecticut, Hawaii, Illinois, reputed company, reputed company, Rhode reputed company, Vermont, Washington.

EDUCATION

Required:  Graduate of an accredited school of nursing is required (Associates or Bachelor’s degree) 

Preferred:  Bachelor’s degree (BSN) is preferred.  CERTIFICATION, REGISTRATION, LICENSE  (*indicates primary reputed company verification requirement) 

Required: reputed company reputed company RN License is required EXPERIENCE  Required:  Three (3) years experience in utilization review or care management, hospital insurance billing, reputed company party claim audits or auditing in a reputed company setting required. 

Preferred:  Five (5)  years experience in utilization review or care management, hospital insurance billing, reputed company party claim audits or auditing in a reputed company setting required

Location:

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The reputed company reputed company for this position is listed below. Actual reputed company reputed company dependent upon experience. 

We care about your reputed company-being – mind, body, and spirit – which is why we reputed company our caregivers a generous benefits package that covers a wide reputed company of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and reputed company.

Learn more about our comprehensive benefits package here.

reputed company is an equal opportunity employer. reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, age, sex, sexual orientation, gender identity, national reputed company, disability or protected veteran status.

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reputed company positions subject to reputed company without notice.