Lead Clinical Appeals Nurse
Purpose:
The Lead Nurse works under the direction of the Manager of Clinical Appeals. The Lead 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 Lead Nurse will maintain regular job duties as a Clinical Appeals Nurse to include billable hours dependent on the business needs of the department.
Reports to:
Manager – Clinical Appeals
Essential Job Functions:
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.
Ideal candidate will possess the following:
o RN with comparable experience and background.
o Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards.
o Working knowledge of billing codes, Revenue Codes, CPT’s, NCD/LCDs, etc.
o Experience and knowledge of managed care contracts, account receivables and revenue cycle functions.
o Working knowledge of provider billing guidelines, payer reimbursement policies, and related industry- based standards.
o Specific knowledge of managed care denials and underpayment decisions.
o Excellent oral and written communication skills.
o Ability to work independently in a fast-paced environment.
o Ability to interact with management personnel.
o Possess strong organizational skills and attention to detail.
o Ability to multi-task and meet multiple deadlines.
o Proven leadership skills including ability to provide necessary oversight to team members.
o Possess strong organizational skills and attention to detail.
o Ability to multi-task and meet multiple deadlines.
Proven leadership skills including ability to provide necessary oversight to team members
Job Type: Full-time
Pay: $40.87 - $48.08 per hour
- Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible schedule
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Referral program
- Retirement plan
- Vision insurance
- Schedule:
- Day shift
- Monday to Friday
Work Location: Remote
Apply Job!
Apply to this Job