About this role
Role Overview
- Conduct Appeals reviews of new evidence presented by auditees
- Document Appeals results according to quality policies
- Review audit documentation and conduct research
- Provide corrections to rationale correlating with audit determinations
- Contribute to continuous improvement feedback processes
- Monitor, track, and report all work conducted
Requirements
- Active unrestricted RN license in good standing
- At least 5+ years relevant experience in a provider or payer environment
- Strong technical aptitude and intermediate to advanced skills using Excel
- ICD-9/ICD-10 coding knowledge
- Experience in health care claims that demonstrates expertise in bundled payment methodologies and/or medical billing
- Familiarity with interpreting electronic medical records (EHR)
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- HSA/FSA options
- Life insurance coverage
- 401(k) savings plans
- Family/parental leave
- Paid holidays
- Paid time off annually