Clinical Appeals Manager (RN)
Fulltime | Remote | Permanent Managed Resources is a leading consulting group assisting healthcare organizations nationwide in optimizing its revenue cycle management through review, recovery and educational programs.Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources! The Clinical Appeals Manager will... work in conjunction with the Director of Clinical Appeals to oversee the various functions of the Clinical Appeals Department for Managed Resources, Inc. As an RN Appeals Manager, you would be responsible for overseeing the appeals process related to denied or underpaid claims within a healthcare organization. Your role would involve a combination of clinical expertise, managerial skills, and knowledge of healthcare regulations and payer guidelines. Description The Clinical Appeals Manager will report directly to the Director of Clinical Appeals. Lead a team of nurses and appeals specialists responsible for reviewing denied claims, assessing medical necessity, and preparing appeals. Assists Director with nurse audits as needed on a quarterly basis. Establish and maintain standardized policies and procedures for the appeals process, ensuring compliance with regulatory requirements and payer guidelines. Assist Director with reports on appeal outcomes, denial reasons, and financial impact. Use data analysis to identify patterns in denials and opportunities for improvement in clinical documentation and appeals management. Attends client meetings as needed and/or required. Implement quality assurance measures to ensure the accuracy and effectiveness of clinical appeal submissions. Monitor the quality of clinical documentation and adherence to medical necessity criteria. Certifications Registered Nurse (RN) License is required. Coding, CCM, and CDI certifications are highly recommended.
Qualifications
Required: Registered Nurse with previous management experience preferred; BSN preferred. Leadership skills to include: Organizing a meeting, completing performance evaluations, ability to present Power Point demonstrations to clients. Possesses knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards. Working knowledge of billing codes, Revenue Codes, CPTs, 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. Experience and success in appealing managed care denials and underpayment decisions. Ability to examine financial and clinical data trends and provide recommended action plan. Check Out Our Benefits: 401(k) 401(k) matching Dental insurance Disability insurance Employee assistance program Flexible spending account Health insurance Life insurance Paid time off Referral program Vision insurance Pet Insurance Monthly Internet Stipend Visit http://jobs.managedresourcesinc.com to find more jobs and sign up for job alerts.Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO Job Type: Full-time Pay: $88,000.00 - $110,000.00 per year Schedule: Day shift Work setting: Remote Work Location: Remote Apply Job!