Clinical Appeals Nurse, RN – Remote

Job Description

CLINICAL APPEALS NURSE ? MANAGED RESOURCES
Full-Time | Remote | Permanent…
Job Overview/Purpose
The Clinical Appeals Nurse works under the direction of the Manager of Clinical Appeals. The Clinical Appeals Nurse will perform quality assurance audits, assist in orientation and training of Clinical Nurses, and assist in planning, implementation, and execution of department and organizational goals. The Clinical Appeals Nurse will maintain regular job duties as a Clinical Appeals Nurse to include billable hours dependent on the business needs of the department.
Founded in 1994 Managed Resources (MRI) in Long Beach California, MRI partners with clients nationwide to help them solve complex revenue cycle and compliance challenges. In our over 25 years of operations, MRI has had the pleasure of working with many of the most prestigious healthcare organizations and medical groups in the county that span from the Hawaiian Islands to the East Coast.
Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources.
DESCRIPTION
? Complete the following functions in accordance with Managed Resources policies:Provides support to Clinical Appeals staff and serves as a resource and subject matter expert
? Conduct quality reviews and assists in feedback to the Clinical Appeals Nurse
? Monitors productivity and quality standards of the Clinical Appeals Nurses
? Helps maintain Elenchus worklists (Pending Manager, Pending Expert Review) and maintains personal work que
? Assists with recruiting, interviewing, and training of employees
? Maintain job duties as a Clinical Appeals Nurse (Appeal writer) with billable hours
? Develops and maintains strong working relationships with other leaders and provides cross coverage as needed
? Trouble shoots client access and other computer problems. Identifies problems and recommends solutions.
? Provides feedback to Manager and Director on operational concerns and oversight of team members
? Exemplifies the core values of Managed Resources
? Other duties as assigned.
QUALIFICATIONS
Ideal candidate will possess the following:
? Valid RN License (required) and comparable experience and background.
? Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards.
? Working knowledge of billing codes, Revenue Codes, CPT?s, NCD/LCDs, etc.
? Experience and knowledge of managed care contracts, account receivables and revenue cycle functions.
? Working knowledge of provider billing guidelines, payer reimbursement policies, and related industry- based standards.
? Specific knowledge of managed care denials and underpayment decisions.
? Excellent oral and written communication skills.
? Ability to work independently in a fast-paced environment.
? Ability to interact with management personnel.
? Possess strong organizational skills and attention to detail.
? Ability to multi-task and meet multiple deadlines.
? Proven leadership skills including ability to provide necessary oversight to team members.
? Possess strong organizational skills and attention to detail.
? Ability to multi-task and meet multiple deadlines.
? Proven leadership skills including ability to provide necessary oversight to team members.
Managed Resources Inc. is an Equal Opportunity Employer (EOE) M/F/D/V/SO