Allegheny Health Network
Registered Nurse Quality Review Specialist - CIC or CCS
This job is now closed
Job Description
- Req#: J273301
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $126,000.00
- Opportunity for career advancement and growth within the organization
- Flexible work environment with office-based or remote options
- Engage in meaningful work that impacts patient care and reimbursement accuracy
- Supportive and collaborative work environment
- Comprehensive benefits package including healthcare and retirement options
What to Expect (Job Responsibilities):
- Review and analyze medical claims for accuracy and compliance with inpatient standards and coding guidelines
- Prepare detailed appeals, including narratives and documentation, to address determinations made on claims
- Maintain organized records of claims, reviews, and appeals
- Stay updated on healthcare regulations and provide expertise on inpatient claim processes
- Follow up with providers to ensure timely resolution of appeal requests and improve documentation practices
What is Required (Qualifications):
- Minimum of 3 years of experience in a clinical setting
- Minimum of 3 years of experience in medical claim review
- Minimum of 3 years of proficiency in medical coding and healthcare software systems
- Minimum of 3 years of familiarity with payer policies and regulations
- Current State of PA RN licensure or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
How to Stand Out (Preferred Qualifications):
- 3 years of experience with electronic health systems
- Bachelor’s degree in Science of Nursing or relevant experience
#HealthcareServices #MedicalCoding #CareerOpportunity #RemoteWork #HealthcareCompliance
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