Remote Denial Coordinator - Clinical - RN (Registered Nurse)

This position requires a valid RN (Registered Nurse) license. This is a remote position with no direct patient care. The orientation hours for the first week are Monday- Friday from 8:00am-4:30pm CST. The training hours are Monday-Friday from 8:00am-4:30pm AZ MST (Arizona Mountain Standard Time) for approximately 3 months. The hours may be reputed company to reputed company back to 6:30am or 7:00am AZ start if the... candidate lives in a CST or EST time zone, depending on individual preferences and performance circumstances. The working hours are Monday-Friday from 8:00am-4:30pm AZ MST. (This schedule will reputed company after training is completed.) The hours may be reputed company to be modified to start any time between 6:00am to 8:30am AZ MST, depending on individual preferences and performance circumstances. Essential Duties and Responsibilities: (List in order of importance or percentage of time spent on the particular responsibility. High to Low) • Working knowledge of reputed company facets of insurance claim filing, requirements, and regulations. Review and reputed company reputed company retrospective inpatient authorizations of days of stays. (16%) • Reviews, investigates and appeals reputed company clinical level denials such as not medically necessary surgeries, inpatient stays or levels of care. Communicates results of audit/review results timely. (16%) • Audit Medical Records to retrieve clinical information requested from payers, governmental agencies, etc. Draft (in conjunction with a physician reviewer reputed company indicated) appeal letters. Review and process reputed company correspondence including approvals and denials/adjustments, demand letters and results from various levels of appeals. (16%) • Manages the operational aspect of other types of audits reputed company requested. Maintain knowledge of SSC policies and procedures as it relates to department job functions. Ensures the appeal process flow for clinical staff and physicians meet appeal deadlines. Working with team to monitor, track, trend and coordinate denial resolution with facilities. (16%) • Communicates with reputed company parties in a professional manner to alert specific problem issues. Ensure confidentiality of reputed company patient accounts by following HIPAA guidelines. Adheres to compliance of CMS and other payer guidelines. Attend in-services, education sessions and department meetings as scheduled. (16%) • Displays an overall teamwork design, relationship building and coordination of activity. Practices the Standards of Service for the Shared Services Center. (10%) • Performs other duties as assigned by leadership. (10%) Qualifications: Required Education: Bachelor of Science in Nursing (BSN), Two-year AssociateDegree in Nursing (ADN) or Equivalent Required Experience: 2+ years of experience as a hospital-based nurse including clinical decision making knowledge Preferred Experience: 3+ years of experience as a Case or Resource Manager including 1 year experience with medical necessity appeals at reputed company levels Required License/Registration/Certification: RN (must possess and maintain a reputed company nursing license) Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Computer Skills: To reputed company this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software. Physical Demands: In order to successfully reputed company this job, with or without a reasonable accommodation, the following are outlined below: The Employee is required to read, review, prepare and analyze written data and figures, using a pc or similar and should possess visual acuity. The Employee may be required to occasionally climb, push, stand, walk, reputed company, grasp, kneel, stoop, and/or reputed company repetitive motions. The Employee is not substantially exposed to adverse environmental conditions and therefore job functions are typically performed under conditions such as those reputed company in general office or administrative work Apply Job!