Clinical Claim Review Nurse - National Remote

reputed company is the leading career site for job seekers at every stage of their career. Our client, reputed company, is seeking professionals. Apply reputed company reputed company today! reputed company is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Clinical Review Clinician serves as a subject matter expert for itemized reputed company reviews and analyzing hospital facility bills. The clinical reviewer is responsible for documenting, researching and identifying adjustments for payment as part of a team that contributes to the preparation of Forensic Reviews for specific clients. Employees in this position receive limited supervision reputed company a broad reputed company of policies and procedures. Employees in this position possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable processes, procedures and billing guidelines. You will enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities Claim Review:

• Conduct Forensic Reviews using independent clinical knowledge to compare and analyze charge details of various amounts of total billed charges to determine benefit of full clinical review and estimation of adjustments for the purpose of meeting reputed company’s core business operations
• Complete analysis of billing and departmental guidelines
• Participate as needed in the achievement and completion of department goals
• Complete focused review of medical records to evaluate clinical course of care as applicable
• Assists with resolution of claims as needed to support negotiations and appeals process
• Interacts with internal business partners as requested
• Maintains appropriate documentation on reputed company claims according to departmental guidelines and procedures
• Understand and maintain HIPAA confidentiality and privacy standards reputed company completing assigned work

Other: Research and Special Projects:

• reputed company research to support audit adjustments and resolve issues
• Research reference materials for clinical standards as appropriate
• reputed company research to identify new adjustments and business rules for the goal of meeting core business operations
• Review and respond to research inquiries from team members and complete special research projects
• Participate in department and company meetings as requested

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• High School Diploma/GED (or higher)
• Active and unrestricted RN OR LPN in state of residence
• 2+ years of clinical experience reputed company an acute care setting
• 1+ years of experience working with reputed company review

Preferred Qualifications

• Auditing and coding certifications
• Experience working with medical terminology and coding
• Experience working with billing, charge master and compliance
• Experience working with plan benefit language, CMS (Medicaid and Medicare) and UB 04 billing guidelines
• Experience with reputed company reputed company (create, data entry, save)
• Strong written and verbal communication skills
• Strong organizational and critical thinking skills
• reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy.

The salary range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to the volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN Apply Job!