Remote Clinical Appeals RN
Remote Clinical Appeals RN
HealthCare Support is actively seeking a Remote Clinical Appeals RN
to fill an opening with a United Health Group MSP (UHG)in Remote United States
Daily Responsibilities for Remote Clinical Appeals RN:
- Review provider post-service appeals for Medicare and Retirement
- Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines
- Discuss cases with medical directors when applicable
- Ability to communicate and collaborate with other teams in order to gather medical information to process cases
- Communicate effectively in both verbal and written documentation
- Must meet quality and productivity metrics
- Ability to work independently and prioritize
- Attend mandatory trainings and scheduled staff meetings
- Engage in respectful and courteous team dialog via email, IM and in staff meeting
- As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims.
RN's will be handling 1 case type only which will be a simple review once they learn all the systems They are essentially working on a CPT diagnosis match. The claims coming into this department were recently denied as the code wasnt accurate. These RN's will review the medical records to see which procedure was actually completed and will do a write up about the appeal and send to medical directors for review on correction.
- Schedule: M-F 8-4:30 CST.
- This is a remote position and requires the ability to effectively support a work from home environment.
- 6 month contract
Required Qualifications
- Undergraduate degree or equivalent experience
- Unrestricted, active RN license
- 2+ years of RN experience (acute setting preferred)
- Proven working knowledge of Clinical Criteria and CMS Guidelines/InterQual
- Must have Utilization Review, Appeals, or Prior-auth experience (managed care is a plus)
- Coding/ Claims experience is a PLUS
- Proven proficiency in basic computer skills
- Demonstrated ability to have high speed internet installed in home for Secure Job use only
- Proven designated HIPPA compliant home workspace
Benefits for Remote Clinical Appeals RN:
- Immediate enrollment in Health Insurance
- Dental Insurance
- Life Insurance
- Employee Assistance Program (EAP)
- Access to Investment Accounts
- Career and educational tools within our Ingenovis ACT (Advocacy) Program
Pay Details: $43.00 to $45.00 /Hour
Interested in being considered?
If you are interested in applying to this position, please click Apply Now for immediate consideration.
For additional consideration, please email a copy of your resume to Rome.Alcaraz@healthcaresupport.com with your phone number, the job title and location, and our recruiters will reach out.
Healthcare Support Staffing, LLC. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.