Job Title
– Appeal Nurse Hours
– 8:00am
– 5:00pm (M
– F) (Normal Business Hours ) Location
– 15 MetroTech Center
– Brooklyn
– New York 11201 Job Summary: Medix is seeking a Appeal Nurse to work for a Fortune 500 company.
Appeal Nurse will be working as Communicating with medical office personnel to obtain pertinent clinical history and information.
Documenting and summarizing clinical or administrative rationale for all approval and denials to all parties involved in the case.
Implements quality assurance plans for specific contracts and coordinates this activity with the appropriate account managers or dedicated quality assurance staff.
Interfaces with other departments to satisfactorily resolve issues related to appeals and retrospective reviews.
Participates in on-going training programs to ensure quality performance is in compliance with applicable standards and regulations.
Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures.
Provides optimum customer service through professional and accurate communication while maintaining accreditation and health plan’s required timeframes.
Documents communications with medical office staff and/or MD provider as required.
Refers cases to appropriate internal reviewers according to the business needs of the particular health plan.
Research requests for post-determination review and categorizes each for processing based on the applicable health plan policies and procedures.
Reviews and coordinates documentation; interprets data obtained from clinical records and ensures appropriate clinical criteria and policies are aligned with regulatory and accreditation requirements for members and providers.
Tracks all post-determination cases to completion to ensure compliance.
Trains new employees on the appeals and de-certification process as needed.
Works closely with the appeals-dedicated Clinical Reviewers to ensure timely adjudication of processed appeals.
Responsibilities Managed care or utilization management experience preferred.
Must be able to exercise independent and sound judgment in clinical decision making.
Must be computer literate and able to navigate through internal and external computer systems.
Strong organizational and effective time management skills; demonstrated ability to manage multiple priorities are a must.
Outstanding interpersonal and negotiation skills to effectively establish positive relationships both internally and externally.
Strong written and verbal communication skills.
Requirement Requires 1-3 years experience and is a LPN About Medix?
Medix is dedicated to positively impacting lives every day.
Since 2001, we have made it our mission to be the leading provider of workforce solutions for clients and candidates across the Healthcare, Scientific, and Information Technology industries .
Our dedicated recruiters are here to help you find and secure just the right opportunity.
We take the time to learn about you, your skills, your interests, and your career goals, and then match you with the jobs and companies that best suit your needs.
Whether you are looking for a contract, contract-to-hire, or direct hire positions, we can help you to find the meaningful and gratifying work that you’ve been looking for.
Let Medix be your partner as you move your career forward.
Contact us today Benefits Once you have been a contract employee of Medix for 30 days, you become eligible for our Benefits Program.
Should you elect to enroll, there are three levels of medical coverage to choose from, supplemental dental plans and term plans as well as the option to enroll your spouse and/or children.
You can select the best combination that best suits your needs.
As a contract employee with Medix, you can choose to enroll in our Benefits Program during your eligibility period and enjoy: Minimum Essential Coverage (MEC) plan Two different fixed indemnity plan add-ons Major Medical Plans, including 1 HSA Plan Dental Vision Short-term disability Life and AD&D This year’s recipient of the Business Ledger’s “Entrepreneurial Excellence Growth Award” Join our network of talented professionals Job Requirements: The LPN/LVN must have a full, active and unrestricted license as a Licensed Practical or Vocational Nurse in State Minimum of one year related work experience to include working with an EMR
Apply Now: https://ift.tt/2WhUDkA
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