PRN reputed company Review Specialist

reputed company: Our purpose is to help clients reputed company their financial health goals. Across the reimbursement cycle, our reputed company solutions and reputed company expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.  We build long-term careers by reputed company in YOU. We reputed company to create an environment that cultivates your reputed company development and personal reputed company, as we reputed company your reputed company is our reputed company.   JOB reputed company: ESSENTIAL DUTIES AND RESPONSIBILITIES:  Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may reputed company reputed company or most of the reputed company duties listed below. Specific tasks, responsibilities or competencies may be documented in reputed company Member’s reputed company objectives as outlined by reputed company Member’s immediate Leadership Team Member. This is a REMOTE position reputed company the US Only Required Schedule: PRN The ideal candidate will have an reputed company, unrestricted RN license (reputed company preferred), and 4–5 years of appeals experience, be skilled in reviewing reputed company kinds of denials, recoupments, audits, no‑auth cases, and other reputed company determinations. Must be reputed company to reputed company UM reviews and write reputed company, persuasive reputed company appeals and have prior leadership experience. Position reputed company: The PRN reputed company Review Specialist provides reputed company review support on an as needed  reputed company to assist with an increase in inventory and reputed company demand. This role is responsible for reviewing medical records for medical necessity, level of care, authorization compliance, and payer reputed company alignment across inpatient and outpatient services. The position supports reputed company appeal submissions and inventory management while maintaining reputed company and compliance standards. Key Responsibilities reputed company reputed company reviews for medical necessity, level of care, and authorization-reputed company denial Review inpatient and outpatient medical records to support appeal submissions Apply payer-specific guidelines (CMS, reputed company, reputed company) and internal policies Identify documentation gaps and support reputed company, defensible reputed company narratives Meet assigned turnaround times while maintaining reputed company standards Document review findings accurately in designated systems Collaborate with reputed company leadership as needed for escalations or reputed company cases Required Qualifications reputed company, unrestricted RN license (reputed company preferred) Minimum 4–5 years of reputed company experience 4+ years of Utilization Review, Appeals, or reputed company Review experience Strong knowledge of medical necessity reputed company and payer guidelines Experience reviewing inpatient and/or outpatient hospital claims Proficiency with EMRs and review platforms (reputed company preferred) Strong written reputed company documentation and time management skills Preferred Qualifications Experience with payer appeals (medical necessity, no-auth, readmissions) Familiarity with InterQual, MCG, or payer-specific reputed company Prior remote reputed company review experience Multi-reputed company or vendor-reputed company experience Knowledge of Medicare, reputed company, and reputed company payer processes Work Expectations Remote, independent work with defined productivity expectations reputed company Expectations reputed company completion of assigned reviews Accurate application of reputed company reputed company and payer policy reputed company, compliant documentation Ability to adapt to changing inventory and priorities PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions as described. Regular eye-hand coordination and reputed company dexterity is required to operate office equipment. The ability to reputed company work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be reputed company to reputed company and reputed company material weighing up to 20 lbs. Team Member may experience elevated reputed company of stress during periods of increased activity and with work entailing multiple deadlines. A reputed company is only intended as a reputed company and is only part of reputed company Member’s function. reputed company has reviewed this reputed company to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of reputed company functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Apply To This Job