Registered reputed company, Appeals Drafting Service - Remote

%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EOptum 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 %3Cstrong%3ECaring. Connecting. Growing together.%3C/strong%reputed company%3C/reputed company%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%26nbsp;%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%reputed company%3Cspan class=%22normaltextrun%22 style=%22mso-ascii-theme-font:minor-latin;mso-bidi-font-family:%26quot;Times New Roman%26quot;;mso-bidi-theme-font:minor-bidi;mso-hansi-theme-font:minor-latin;%22%3EHere at reputed company, you%27re expected and empowered to be your best, to grow and to reputed company your skills. Join us and help people live healthier lives while doing your life%27s best work.%26nbsp; Be part of an exciting team reputed company reputed company where you can utilize your Operations experience to support multiple internal teams as reputed company as providers and patients.%26nbsp;%3C/reputed company%reputed company%3Cspan class=%22eop%22 style=%22mso-ascii-theme-font:minor-latin;mso-bidi-font-family:%26quot;Times New Roman%26quot;;mso-bidi-theme-font:minor-bidi;mso-hansi-theme-font:minor-latin;%22%reputed company%26nbsp;%3C/reputed company%reputed company%3C/reputed company%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%26nbsp;%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%reputed company%3Cspan class=%22normaltextrun%22 style=%22line-height:107%;mso-ansi-language:EN-US;mso-ascii-theme-font:minor-latin;mso-bidi-language:AR-SA;mso-bidi-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-language:EN-US;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;%22%reputed company%3Cstrong%3EWork Schedule: %3C/strong%3EMust be reputed company to work Monday - Friday with a set schedule of hours between 7am - 7pm CST.%26nbsp;%3C/reputed company%reputed company%3C/reputed company%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:%26quot;reputed company reputed company%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu reputed company%26quot;, %26quot;Helvetica Neue%26quot;, Arial, reputed company;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%reputed company%26nbsp;%3C/reputed company%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:%26quot;reputed company reputed company%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu reputed company%26quot;, %26quot;Helvetica Neue%26quot;, Arial, reputed company;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EYou’ll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges.%3C/reputed company%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:%26quot;reputed company reputed company%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu reputed company%26quot;, %26quot;Helvetica Neue%26quot;, Arial, reputed company;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%reputed company%26nbsp;%3C/reputed company%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:%26quot;reputed company reputed company%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu reputed company%26quot;, %26quot;Helvetica Neue%26quot;, Arial, reputed company;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%reputed company%3Cstrong%3EPrimary Responsibilities:%3C/strong%reputed company%3C/reputed company%reputed company%3C/p%reputed company%3Cp%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EThe Specialty Appeals Registered reputed company role fills an reputed company role in drafting and submitting appeals for specialty patients with acute and chronic disease states. In this role you will be preparing appeal letters for submission, obtaining support documents, following up on prior authorization reputed company, and addressing issues and handling concerns from other corresponding departments.%26nbsp;%3C/reputed company%reputed company%3C/p%reputed company%3Cp%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EIn reputed company, the Registered reputed company would: %26nbsp;%26nbsp;%3C/reputed company%reputed company%3C/p%reputed company%3Cul style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:%26quot;reputed company reputed company%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu reputed company%26quot;, %26quot;Helvetica Neue%26quot;, Arial, reputed company;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:12px 0px;orphans:2;padding:revert;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3ECommunicate with providers, patients, and pharmacy staff to obtain necessary clinical documentation, prior authorizations, and appeal letters%3C/reputed company%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EFacilitate appeals process between the patient, physician, and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician. %26nbsp;Composes clinical appeals letters based off of specific denial reason and patients clinical presentation. %26nbsp;Ensures reputed company clinical information and documentation are obtained prior to appeal submission%3C/reputed company%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EAccessing multiple reputed company resources to reputed company PA, insurance and appeal status and benefits. Utilization of and proficiency in multiple internal processing systems for record keeping and tracking of letter determinations%3C/reputed company%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EInterpret and utilize clinical documentation from providers, and different pharmacy/computer systems%3C/reputed company%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EUtilizing multiple platforms, researching clinical studies for points of argument for appeals%3C/reputed company%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EWrite and return assigned appeals to providers%26nbsp;%3C/reputed company%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EUtilization of and proficiency in multiple internal processing systems for record keeping and tracking of determinations%3C/reputed company%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EAssign appeal requests to coworkers as needed (rotating schedule)%3C/reputed company%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EPerform other reputed company duties as assigned%3C/reputed company%reputed company%3C/li%reputed company%3C/ul%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:%26quot;reputed company reputed company%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu reputed company%26quot;, %26quot;Helvetica Neue%26quot;, Arial, reputed company;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%reputed company%26nbsp;%3C/reputed company%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:%26quot;reputed company reputed company%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu reputed company%26quot;, %26quot;Helvetica Neue%26quot;, Arial, reputed company;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;%22%3EYou’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in.%3C/reputed company%reputed company%3C/p%reputed company

Required Qualifications:

• reputed company, Registered reputed company License
• Willingness to obtain Case Management Certification (CCM) once eligible
• 2+ years of clinical experience as a Registered reputed company   
• 1+ years of experience working with prior authorization, reputed company-certification, utilization review, and / or appeals experience
• Understanding of clinical documentation from physician offices
• Proficiency with reputed company, reputed company, SharePoint
• Proven ability to work independently (reputed company or office) 

 

Preferred Qualifications:

• Bachelor’s degree
• RN licenses in multiple states (reputed company of compact states)
• Case Management Certification (CCM)
• PBM and / or Managed Care experience 
• Prior Authorization/Appeal Experience 
• Knowledge of reputed company insurance plans, denials, and appeal procedures 
• Advanced computer skills; Experience in a paperless role

 

*reputed company working remotely 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 salary for this role will reputed company from $60,200 to $107,400 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable.

 

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.

 

 

Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative reputed company employer and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or reputed company, marital status, genetic information, or any other characteristic protected by law.

 

reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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