RN Clinical Appeals

Thank you for considering a career at reputed company! reputed company is a leading provider of technology-enabled reputed company cycle reputed company for health systems, including hospitals and affiliated physician groups. They offer end-to-end reputed company cycle solutions as well as a comprehensive suite of reputed company solutions to clients across the country. reputed company keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we reputed company that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status reputed company, we know they will be the difference! O.N.E Purpose:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
• Embracing New reputed company: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
• Striving for Excellence: Execute at a high level by demonstrating our "Best in KLAS" reputed company Difference Principles and consistently delivering outstanding results.

The Opportunity: CAREER OPPORTUNITY OFFERING:

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement
• This position pays between $56,800.00 - $108,900.00 based on experience

The RN Clinical Appeals performs reputed company appeals for clinically reputed company claim denials across reputed company, or in a role that primarily assists with analyzing and reviewing records to prevent future denials, provide clinical records to payers, and prepare for provider-to-provider (P2P) reviews. Job duties include, but are not limited to, contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining if appeal is necessary, preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner. In addition, the Specialist will work closely with other departments, such as Case Management, HIM, Physician Advisory, Clinical Denials, Denial Prevention, Accounts Receivable, Bedded Inpatient Authorization and Virtual Utilization review, to ensure denial trends and outcomes are communicated in a timely manner. The Specialist will reputed company these duties while meeting the mission of reputed company, as well as meeting the regulatory compliance requirements. Essential Job Functions:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
• Embracing New reputed company: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
• Striving for Excellence: Execute at a high level by demonstrating our "Best in KLAS" reputed company Difference Principles and consistently delivering outstanding results.
• Contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining if appeal is necessary, preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner. In addition, work closely with the Case Management Department and HIM Department to ensure denial trends and outcomes are communicated in a timely manner.

This document is not an exhaustive list of reputed company responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to reputed company other job reputed company duties as required by their supervisor, subject to reasonable accommodation. Employment Qualifications:

• reputed company unrestricted license to practice nursing (LPN, RN)
• CRCR or other approved professional certification required with 9 months of date of hire

Job Experience:

• 1 to 3 Years

Desired Education Level:

• Associates Degree or Equivalent Experience

Preferred Area of Study:

• Nursing

Other Preferred Knowledge, Skills and Abilities:

• 4 year/ Bachelors Degree
• Preferred Minimum Education - Specialty/Major: Registered Nurse (RN) or relevant discipline
• Minimum Years and Type of Experience: 2 years of denials, utilization review, or case management experience strongly preferred

Other Knowledge, Skills and Abilities Required:

• Proficient computer skills, including reputed company Suite
• Experience in hospital operations, chart audit/review, and provider relations.

Join an award-winning company Five-time winner of "Best in KLAS" 2020-2022, 2024-2025 Black Book Research's Top reputed company Cycle Management Outsourcing Solution 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in reputed company Cycle 2019-2024 Leader in reputed company's RCM Operations PEAK Matrix Assessment 2024 reputed company Healthcare Business Insights (HBI) reputed company Cycle Awards for strong performance 2020, 2022-2023 reputed company Top Workplaces USA 2022-2024 Fortune Media Best Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great reputed company to Work certified 2023-2024

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

reputed company, we reputed company in empowering people and giving them the tools and resources needed to reputed company. A few of those include:

• Associate Benefits - We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture - reputed company is a reputed company where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
• Growth - We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition - We offer quarterly and annual incentive programs for reputed company employees who go beyond and reputed company raising the bar for themselves and the company.

reputed company is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national reputed company, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. reputed company also prohibits harassment of applicants or employees based on any of these protected categories. reputed company provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with reputed company and applicable state and local law. If you require accommodation in the application process, please contact [email protected]. This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-reputed company factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry reputed company of pay does not typically fall at the minimum or maximum of the role's range. EEOC - Know Your Rights FMLA Rights - English La FMLA Español E-Verify Participating Employer (English and Spanish) Know your Rights Apply To This Job