Contract Clinical Appeals RN
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Job Location:
Houston, MS - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
The Appeals Nurse will review medical records to construct compelling clinical appeals in order to overturn managed care denials based upon clinical nursing judgment and the medical necessity of services delivered.
Duties and Responsibilities:
- Review of medical records to evaluate the validity of 3rd party denials.
- Assess strength of completed appeal to predict favorable outcomes.
- Ability to detect issues resulting in denials and constructively report on issue to assist in resolution.
- Construct 1st and 2nd level appeals by applying clinical rationale.
- Manage assigned workload of accounts so appeals are submitted timely in accordance with payer timeframes.
Qualifications :
- Licensed RN.
- 5 years experience working in acute hospital setting.
- Knowledge of managed care and utilization review process.
- Knowledge of Interqual criteria and/or Milliman Guidelines.
- Knowledge of DRGs.
- Excellent written skills.
- Proficient computer skills including Microsoft Office with access to high-speed internet.
- Experience as a Case Manager or UR nurse who has written appeals is required.
Additional Information :
This role does not offer an hourly rate. Payment is a 1099 paid bi-weekly upon Reviews. We will pay $50 per Appeal and $25 per Review if cannot be appealed. You will also be paid $25/hour for any IT/ Compliance trainings that require completion of your time.
All your information will be kept confidential according to EEO guidelines.
EEOC and Veteran Documentation
During employment employees are treated without regard to race color religion sex national origin age marital or veteran status medical condition or handicap or any other legally protected status.
At times government agencies require periodic reports from employers on the sex ethnicity handicap veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping reporting and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information please note that all
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.
Remote Work :
Yes
Employment Type :
Full-time
Key Skills
- IVR
- SOAP
- Avaya
- Solaris
- Cost Accounting Standards
- Database Design
- Hibernate
- ITIL
- Weblogic
- Express.js
- Contracts
- ASP
About Company
Sutherland is seeking an organized and reliable person to join us as Admin Specialist. We are a group of driven and supportive individuals. If you are looking to build a fulfilling career and are confident you have the skills and experience to help us succeed, we want to work with you ... View more
