Appeals RN

Job Title: Utilization Management / Appeals RN

Location: Highly preferred for nurses to work in the office in either Lake Success (New Hyde Park) or Albany, NY

***open to hybrid or fully onsite

Hours: M-F 8-5

Start date: ASAP, looking to get all RNs started together

Pay: $48-52/hr+ (negotiable)

Experience: UM, Appeals, or strong analytical background to do claims adjudication.

Education: BSN required

DUTIES:

1. Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, complete electronic worksheets and preparing final determinations.
2. Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles.
3. Training and mentoring new RNs as the project expands.
4. Claims assessment and adjudication.
5. Participate in collaborative training.

QUALIFICATIONS:

1. Knowledge and experience with electronic medical records.
2. Ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
3. Excellent written and verbal skills.
4. Ability to work independently with little supervision.
5. Ability and desire to be flexible, innovative, and creative.

Volume: Will do appeals work under the IDR team handling on average 10 cases a day. These will be a mix between simple and complex cases. They will be reviewing documentation, codes, and more for out of Network bills and cost and making determinations on how to move forward based on the evidence.

Benefits:

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances)

• Health Benefits / Dental / Vision (Medix Offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s).)

• 401k (eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1)

• Short Term Disability Insurance

• Term Life Insurance Plan