Medical Claims Reviewer RN - Behavioral Health (REMOTE)

Medical Claims Reviewer RN - Behavioral Health (REMOTE)

Medix Healthcare

Remote - RN License Compact (AZ Required)

$40.00-$42.00 an hour - Full-time

Job Details

Salary

$40.00-$42.00 an hour

Job Type

Full-time - Contract/Temp Position (Expected Duration: Sept-Oct 2024)

Qualifications

• Active Registered Nurse License, Multi-State/Compact (AZ Included)
• 2+ Years of Clinical Behavioral Health Experience (acute care hospital, OP clinic setting, detox, etc)
• 2+ Years of Chart Review Experience from a MCO Insurance Plan (UM, clinical review, quality review, admissions review, etc)

Full Job Description

Are you a Registered Nurse that is looking to join a progressive organization that specializes in projects related to Quality Improvement? We are looking to hire a Registered Nurse to support our Claims Review-Behavioral Health outpatient services, both pre-payment and post-service claims! This will provide assurance to our members that they are getting the access to treatments they require, in addition to ensuring CMS guidelines are being followed in line with a state specific Medicaid plan. Get your career started with us today by applying!

**This position is a contract-temp role that is expected to last through September/October with potential of extension - No gurantees**

What we provide to you as a full-time teammate:

We offer a competitive benefits package that is on par with most of the leading healthcare organizations, along with a 401K plan. Apply today if you are interested in getting your name in the mix!

Requirements

Summary: The RN will utilize standard criteria to review post-service and prepayment reviews of OP Behavioral Health claims. The nurse will utilize HCPC codes (ex H0004, H2017, S9480, etc) to ensure claims are being charted for correct processing of Arizona Medicaid-AHCCCS requirements.

Essential Duties and Responsibilities: Include the following, other duties may be assigned.

As a Registered Nurse (Medical Claims Reviewer - Behavioral Health), you will...

• Conduct clinical claims reviews on potentially fradulent Behavioral Health, OP service claims.
• Will support both pre-payment and post-service claims (n/a screening for medical necessity).
• Follow set guidelines and critiera designed specifically for the project (n/a MCG, InterQual).
• Review claims and the assigned medical codes (HCPCs) to determine validity of services to determine those potentially billed and serviced incorrectly.
• Utilizing AHCCCS specific claims programs in addition to Microsoft/Excel.
• Held to a metric of 12-18 claims reviews per day post-training.

**Initial Onboarding/Training will be the first 2-3 weeks of employment virtually.**

Expectations of Performance: The employee in this role shall be considered to be performing in an acceptable manner when carrying out the Core Values:

• Detail Oriented
• Adaptability
• Analytical
• Independent Worker
• Tech Savvy

Education and/or Experience:

• Active Registered Nurse License, Multi-State/Compact (AZ Included)
• 2+ Years of Clinical Behavioral Health Experience (acute care hospital, OP clinic setting, detox, etc)
• 2+ Years of Chart Review Experience from a MCO Insurance Plan (UM, clinical review, quality review, admissions review, etc)

Computer Skills: To perform this job successfully, an individual should have knowledge of basic office equipment such as: "EMR" - (electronic medical record system), Microsoft Office, computer, internet, email, copy and fax machines, and telephone.

Job Type: Full-time only

Pay: $40.00-$42.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Vision insurance
• Medical insurance
• AD&D
• Short and long term disability
• PTO
• Critical Illness

Schedule:

• M-F, 8am-5pm (Employees Timezone PST/MST/CST/EST)
• Equipment Provided: Laptop, monitors, keyboard, mouse, etc