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Registered Nurse - Clinical Appeals (Remote)

Job ID: 4671721
Updated: Today
Geographic Location: 
Department: HIM Operations
Full/Part Time: Full-Time
Shift: Days
Standard Hours: 40
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Job Summary

The Registered Nurse - Clinical Appeals position is responsible for drafting, finalizing and sending clinical appeal letters in order to reverse a denial for payment on an insurance claim and clinical validation audits.

Essential Functions:

  • The RN will begin by reviewing account specifics and evaluating how to follow up with the payer on the denied claim.
  • The RN will use the provided tools and patient medical records, working within and through the regulations to develop a documented response to the denial and overturn the payer's decision. Clinical appeals are to be professional, appropriate with respect to the denial reason, grammatically correct, supported by medical records as applicable and of the standard to be maintained as supporting documents for the claim.
  • The RN will stay current with assigned accounts and follow-up on the appeal after submission. Following the action taken within the letter, the RN notes all accounts appropriately per the objective quality standard.

 

Qualifications - Minimum

  • Case Management and/or CDI experience preferred
  • Working knowledge of the Hospital Revenue Cycle preferred
  • Must be a licensed Registered Nurse that is currently active and in good standing with the Board of Nursing, within the United States
  • Associates in Nursing required at minimum with a Bachelor in Nursing preferred
  • Ability to pass the Certified Revenue Cycle Representative examination offered through the Healthcare Financial Management Association within 90 days of license issuance at time of hire, unless already certified

Shift and Job Schedule

Full-Time at 40 Hours/Week from 8:00am-4:30pm EST.

This is a fully remote position.

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

About Us

This position will be a part of the revenue cycle team at Ensemble Health Partners - a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.

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