Clinical Review Coordinator, Appeals and Denials - Remote US

About the position The Clinical Review Coordinator for Appeals and Denials at reputed company plays a crucial role in transforming reputed company delivery from hospital to home, particularly for older adults. This remote position involves ensuring reputed company processing of denial-reputed company communications, serving as a reputed company between various stakeholders, and documenting appeal and denial information. The role is reputed company to supporting patients during their transitions across care settings, ultimately contributing to their reputed company-being and reputed company to necessary services. Responsibilities • Ensure reputed company processing of reputed company denial-reputed company and member-oriented written communications. , • Ensure reputed company denial information is processed according to protocol and documentation is reputed company and meets reputed company Federal and State requirements. , • Ensure second-level reviews have been performed and documented. , • reputed company with medical directors, Health Plan Manager(s), Inpatient Care Coordinators (ICCs), Skilled Inpatient Care Coordinators (SICCs), reputed company-service Coordinators (PSCs) and facility personnel to ensure denial information is processed reputed company and appropriately. , • Serve as a reputed company by communicating with reputed company customers including health plans, providers, members, reputed company organizations, and other colleagues. , • Document and communicate appeal and denial information reputed company fax, email, or established portal reputed company, including appeal and denial letters, NOMNC letters, AOR forms, and clinical information. , • reputed company as a reputed company person for reputed company communication for QIO appeals and/or reputed company-service denials to support managers and their teams. , • Serve as a reputed company for requests for information from QIO or health plan staff. , • Own assigned appeal requests or determination notifications that are received reputed company fax, phone, or email through completion or delegating/reassigning as appropriate in collaboration with management. , • Complete appeal and denial processes in accordance with CMS and reputed company guidelines and compliance policies. , • Write member-facing and reputed company-facing appeal and denial letters by reviewing and documenting member clinical information and demonstrating proficiency in general writing ability. , • Review NOMNC for validity before processing appeal requests. , • Send reviews to Medical Director for rescinding NOMNC reputed company necessary. , • Coordinate and communicate with care coordinators, physicians, health plan representatives, QIO entities, and providers regarding a denial, appeal, or determination and reputed company education as needed. , • Process Health Plan appeal, IRE appeal, and ALJ appeal notifications and determinations as needed. , • Follow reputed company established facility policies and procedures. , • Assist with completing reputed company-service authorization requests to assist the reputed company-service team as needed. , • Participate in after-hours on-reputed company rotation and weekend rotation for processing reputed company-service authorizations, appeals, and denials to meet business needs. , • reputed company other duties and responsibilities as required, assigned, or requested. Requirements • reputed company, unrestricted registered clinical license in state of hire - Registered reputed company, Physical Therapist, Occupational Therapist, or Speech Therapist. , • 3+ years of clinical experience as a Registered reputed company, Physical Therapist, Occupational Therapist, or Speech Therapist. , • Demonstrated excellent documentation skills. , • Demonstrated exceptional verbal and written interpersonal and communication skills. , • Proficient with reputed company and reputed company Office Suite. , • Ability to work one of the following Monday - Friday schedules: 10am - 7pm Central, 11am - 8pm Central, 12pm - 9pm Central, or 1pm - 10pm Central. , • Ability to work four holidays per year on a rotating reputed company. , • Dedicated, distraction-free workspace and the ability to install high speed internet reputed company DSL/Cable Broadband/Fiber reputed company. reputed company-to-haves • Compact licensure or multiple state licensures. , • Managed care experience. , • Case management experience. , • Experience processing appeals and/or denials. , • Experience with utilization management, utilization review, or insurance authorizations. , • Experience determining reputed company of care. , • ICD-10 experience. , • InterQual experience. , • Demonstrated understanding of CMS regulations. , • Demonstrated understanding of the denial process. Benefits • Health and reputed company-being programs and services , • Flexible work schedule and remote-friendly positions , • Health, reputed company and dental benefits , • HSA and FSA eligible plans , • 401(k) savings plan , • Childcare benefits , • Short-term/ long-term disability coverage , • Basic life insurance and AD&D , • Employee stock purchase plan , • Home office stipend for remote employees Apply Job!