DRG Nurse Reviewer Appeals and Hearings- Remote Job at Gainwell Technologies LLC, Florida

UU94aHNyeTRna3hpZFZtdER0VWl4Z08y
  • Gainwell Technologies LLC
  • Florida

Job Description

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

 

Sign-on bonuses are available for highly qualified candidates.

Summary

We are seeking a talented individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform all appeal related duties including analyzing and responding appropriately to appeals from providers; reviewing documentation to ensure all aspects of the appeal have been addressed properly and accurately; prepare case files and case summaries for hearings; and participate in in virtual and on-site hearings.

Your role in our mission

  • Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal determinations clearly and concisely.
  • Analyzes and reviews appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards.
  • Prepares case files and case summaries for hearings and actively participates in hearings in conjunction with the Medical Director.
  • Assists management with training new reviewers to include daily monitoring, mentoring, feedback and education.
  • Maintains current knowledge of clinical criteria guidelines and/or coding guidelines; successfully completes required CEUs to maintain RN license and/or coding certification.
  • Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
  • Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.

What we're looking for

  • Active, Unrestricted RN license from the United States and in the primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), required
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) required
  • 5+ years clinical experience or 5+ years medical record coding experience preferred
  • Working knowledge of the appeals and hearings process
  • Excellent written communication skills including ability to write clear, concise, accurate, and fact-based rationales in support of appeal determinations.
  • Excellent oral communication skills with particular emphasis on verbally presenting case summaries and decisions.
  • Ability to multi-task in a fast-paced production environment.

What you should expect in this role

  • Remote (Work from Home)
  • Up to 25% Travel for onsite hearing testimony

 

This position is for pipeline purposes, and we welcome applications on an ongoing basis.

 

 

The pay range for this position is $90,000.00 - $99,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

 

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

 

Gainwell Technologies  is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. 

Job Tags

Full time, Work from home, Relocation package, Flexible hours

Similar Jobs

Careerscape

Administrative Assistant Job at Careerscape

 ...interested in building a career in administration, business operations, office management, or executive support. The Administrative...  ...~ High attention to detail and accuracy ~ Proficiency with Microsoft Office and Google Workspace ~ Ability to prioritize multiple... 

Veterans Affairs, Veterans Health Administration

Community Living Center Registered Nurse Job at Veterans Affairs, Veterans Health Administration

 ...direct patient care positions unless they are proficient in basic written and spoken English ~ Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program... 

Federal Express Corporation

Handler Warehouse - Part Time (Warehouse like) Job at Federal Express Corporation

 ...completing 90 continuous days of employment. Additional Posting Information: Part time Shift 1 - (Wed;Tue;Fri;Sat;Thu - 07:00 AM to 10:30 AM) Shift 2-(Fri;Thu;Wed;Tue;Mon - 5:00 PM from 9:30 PM) - Base pay rate - $21.06/hr. Drug Test required. EEO... 

Ladder

Electrician apprentice/ Electrician’s helper with M.B. Davis Electric Job at Ladder

Must be Willing to: Work +8 hour days, weekends, and, on occasion, holidays. This includes shutdowns and emergency calls. Continue to learn the electrical trade, the tools, and materials needed to complete the task at hand properly. Willing to be flexible and...

Senior Helpers - South Tacoma, WA

Certified Caregiver - In-Home Care (CNA / HCA) Job at Senior Helpers - South Tacoma, WA

Caregiver - In-Home Senior CarePart-Time | Full-Time | Flexible Hours | Meaningful WorkPay: $20.50 - $24.00 per hour (depending on experience...  ...encourage Washington State Certified Nursing Assistants (CNA) and Home Care Aides (HCA) to apply. If you already have your...