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Remote Pre Pay Clinical Registered Nurse Specialist IV

Job is Expired
Location: Nationwide
Compensation: To Be Discussed
Staff Reviewed: Tue, Feb 07, 2023
Job Category: Healthcare
Weekly Hours: Full Time
Employment Status: Permanent
Employer Type: Employer
Career Level: Experienced, Senior Level
Education Level: Bachelors

Job Summary

A non-profit health insurance company is in need of a Remote Pre Pay Clinical Registered Nurse Specialist IV.

Individual must be able to fulfill the following responsibilities:

  • Determine claim level financial impact based on unique member benefits and provider contract terms and rates
  • Leverage clinical and coding background to assess high risk claims for inappropriate application
  • Perform claims level analysis of appropriate provider coding and billing practices and/or guidelines

Must meet the following requirements for consideration:

  • RN - Registered Nurse - State Licensure And/Or Compact State Licensure Hold an active clinical certification
  • Related Bachelor's degree or additional related equivalent work experience
  • 5+ years related work experience
  • Experience Details: Strong familiarity with ICD-9/10, DRG, CPT/HCPCS coding
  • OR Experience with and knowledge of multiple provider reimbursement and pricing methodologies

COMPLETE JOB DESCRIPTION

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