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Appeals Nurse (Hybrid) VillageCareMAX 112 Charles Street, New York, NY 10014 VillageCare is looking for a self-motivated and passionate RN for our Appeals Nurse position. While supporting the ...

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Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Resolving member clinical grievances (complaints).
Conducts investigations and reviews of member grievances and potential quality of care issues.
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By Good Samaritan Hospital At , Suffern, 10901, Ny
Must have working knowledge of utilization management, case management and process improvement.
Must have base knowledge of clinical coding and reimbursement and/or claims management.
Must have demonstrated knowledge of industry trends in Managed Care.
Must have demonstrated expertise in insurance, managed care and federal/ state coverage.
Work requires a high level of problem solving skills.
Must have clear and concise writing skills.

Are you a Registered Nurse looking for a unique opportunity to use your clinical expertise from the comfort of your own home? We are looking for a Clinical Appeals Registered Nurse to join our team and help us provide quality care to our patients. As a Clinical Appeals Registered Nurse, you will be responsible for reviewing appeals and making decisions based on clinical criteria. If you are looking for an exciting and rewarding career, this is the perfect opportunity for you!

Overview:

A Clinical Appeals Registered Nurse – Telecommute is a professional nurse who works remotely to review and process appeals for medical claims. The nurse is responsible for reviewing medical records, determining the validity of the appeal, and making a recommendation to the insurance company. The nurse must be knowledgeable in medical coding, billing, and appeals processes.

Detailed Job Description:

The Clinical Appeals Registered Nurse – Telecommute is responsible for reviewing medical records and claims to determine the validity of appeals. The nurse must be able to interpret medical records, understand medical coding and billing, and be familiar with the appeals process. The nurse must be able to make recommendations to the insurance company regarding the appeal. The nurse must also be able to communicate effectively with the insurance company and the patient.

What is Clinical Appeals Registered Nurse – Telecommute Job Skills Required?

• Knowledge of medical coding and billing
• Knowledge of the appeals process
• Ability to interpret medical records
• Ability to communicate effectively with insurance companies and patients
• Ability to make recommendations to insurance companies
• Ability to work independently

What is Clinical Appeals Registered Nurse – Telecommute Job Qualifications?

• Registered Nurse (RN) license
• Bachelor’s degree in Nursing
• 3+ years of experience in medical coding and billing
• Experience in the appeals process
• Excellent communication and interpersonal skills

What is Clinical Appeals Registered Nurse – Telecommute Job Knowledge?

• Knowledge of medical coding and billing
• Knowledge of the appeals process
• Knowledge of medical terminology
• Knowledge of medical records

What is Clinical Appeals Registered Nurse – Telecommute Job Experience?

• 3+ years of experience in medical coding and billing
• Experience in the appeals process
• Experience working with insurance companies

What is Clinical Appeals Registered Nurse – Telecommute Job Responsibilities?

• Review medical records and claims to determine the validity of appeals
• Interpret medical records
• Communicate effectively with insurance companies and patients
• Make recommendations to insurance companies
• Work independently and meet deadlines