Remote Registered Nurse

We are seeking skilled Medicaid Claims Reviewers with a solid clinical Behavioral Health background to join our remote team. We are assisting AZ AHCCCS in identifying and addressing fraudulent claims related to Behavioral Health services.

Project Alignment
* Specifically aligned with AZ Medicaid-AHCCCS
* Addressing issues identified last year regarding incorrect billing and servicing of Behavioral Health services for AHCCCS patients

Key Responsibilities
* Review AHCCCS claims, both prepayment and post-service, to identify potential fraud
* Verify if the services were actually provided
* Ensure services were done, billed, or coded correctly
* Utilize AHCCCS-specific programs and Microsoft Office apps (e.g., Excel)

Population
* High frequency of Mental Health, Substance Abuse, and Detox services among AHCCCS patients
* Phoenix, the 5th most populated US city, has a significant tribal community presence with at least five surrounding the city

Workload
* Review approximately 12-18 claims per day (varies daily)

Team:
* Collaborate with a Director and Associate Project Director (both experienced nurses)
* Work alongside many other nurses from across the US on this project

Qualifications
* AZ RN License or compact state license (preference for those in AZ) OR active AZ LCSW or LMSW license
* Master's degree for licensed behavioral health professionals
* Minimum 2 years of clinical Behavioral Health experience
* Minimum 2 years of chart review experience (UM, clinical review, quality review, etc.)

Nice to Have
* Remote work experience

Soft Skills
* General understanding of the changing healthcare environment
* Strong analytical and attention to detail skills
* Excellent communication and teamwork abilities

Schedule
* Monday to Friday, 8:00AM - 5:00PM

Pay
* $40 to $42 an hour