Highmark Inc.
Registered Nurse Quality Review Specialist - CIC or CCS
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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 the option for remote work
- Supportive and collaborative work culture
- Chance to make a significant impact in the accuracy of medical claims processing
What to Expect (Job Responsibilities):
- Review and analyze medical claims for accuracy and compliance with inpatient standards and coding guidelines
- Prepare comprehensive appeals with detailed narratives and supporting documentation for providers
- Maintain organized records of claims, reviews, and appeals
- Stay updated with current healthcare regulations and policies
- Provide expertise and guidance on inpatient claim processes and best 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 current 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 #MedicalClaims #RemoteWork #CareerGrowth #CodingExpertise
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