Senior Appeal and Denial Specialist - Remote SD
Sanford Health, Myrtle Point, Oregon, United States, 97458
Overview
Employer Industry: Healthcare Services Why consider this job opportunity: Salary range up to $34.50 per hour Remote work option available for flexibility Opportunities for professional development and career advancement within a large health system Supportive work environment focused on health and healing Chance to make a significant impact on patient care and clinical best practices What to Expect
Facilitate the denial and appeal process by reviewing medical records for medical necessity and policy requirements Track appeals through various levels, ensuring timely filing according to contracts and regulations Conduct reviews of clinical-based denials utilizing clinical criteria and considerable clinical judgment Coach patients and families on proactive care management and resolve common barriers to patient progress Collaborate with departments for external audits and establish best practices for compliance What is Required
Bachelor\'s degree required; relevant experience may be considered in lieu of a degree Three (3) years of experience in appeals, medical necessity, or prior authorization processes If a graduate of a nursing program, must be currently licensed with the applicable State Nursing Board Demonstrated understanding of regulatory requirements and timeframes Strong communication skills for effective collaboration and problem-solving How to Stand Out
Graduate from a nationally accredited nursing program Experience working with multiple healthcare organizations or providers Familiarity with government and industry audit practices and requirements We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.
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Employer Industry: Healthcare Services Why consider this job opportunity: Salary range up to $34.50 per hour Remote work option available for flexibility Opportunities for professional development and career advancement within a large health system Supportive work environment focused on health and healing Chance to make a significant impact on patient care and clinical best practices What to Expect
Facilitate the denial and appeal process by reviewing medical records for medical necessity and policy requirements Track appeals through various levels, ensuring timely filing according to contracts and regulations Conduct reviews of clinical-based denials utilizing clinical criteria and considerable clinical judgment Coach patients and families on proactive care management and resolve common barriers to patient progress Collaborate with departments for external audits and establish best practices for compliance What is Required
Bachelor\'s degree required; relevant experience may be considered in lieu of a degree Three (3) years of experience in appeals, medical necessity, or prior authorization processes If a graduate of a nursing program, must be currently licensed with the applicable State Nursing Board Demonstrated understanding of regulatory requirements and timeframes Strong communication skills for effective collaboration and problem-solving How to Stand Out
Graduate from a nationally accredited nursing program Experience working with multiple healthcare organizations or providers Familiarity with government and industry audit practices and requirements We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.
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