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Job Posting Title RN Appeals Analyst Medicare Part B - CGS
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Job Description
- Req#: R1049221
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits package including subsidized health plans, free vision coverage, and life insurance
- Paid annual leave that increases with tenure and nine paid holidays
- 401(k) retirement savings plan with company matching contributions
- Supportive and collaborative work environment
- Continuing education funds for additional certifications and certification renewal
What to Expect (Job Responsibilities):
- Document the basis of appeals or retrospective reviews in an accurate and timely manner in accordance with regulations and standards
- Conduct thorough research on service appeals from both members and providers based on clinical documentation and policies
- Perform appeal and retrospective reviews to determine the precedence of issues in applying policies to clinical information
- Undertake special projects, including clinical reviews to identify quality of care issues
- Ensure compliance with confidentiality regulations regarding protected health information
What is Required (Qualifications):
- Associate's degree in a job-related field
- Graduate of an accredited School of Nursing
- Minimum of 2 years clinical experience plus 1 year in utilization/medical review, quality assurance, or home health, OR 3 years clinical experience
- Active, unrestricted RN license from the United States and in the state of hire, OR active compact multistate unrestricted RN license
- Strong clinical experience including home health, rehabilitation, and/or broad medical-surgical experience
How to Stand Out (Preferred Qualifications):
- Experience in Utilization Review / Medical Review
- Knowledge of MCS Systems and Medicare Part B
- Familiarity with claims systems and coding experience
- Ability to effectively use Microsoft Office applications, such as Word, PowerPoint, and Excel
#HealthcareServices #AppealsAnalyst #CareerOpportunity #CompetitiveBenefits #NursingJobs
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