Clinical Claims Nurse

Akkodis; United States; Remote; USD 65,000; Full time

Job summary

Akkodis is seeking a Medical Dispute Resolution Specialist, Level III, to work fully remotely. This role involves reviewing and resolving medical disputes and appeals, requiring a solid background in healthcare, along with educational qualifications as an RN or LLP. An ideal candidate will have experience in Medicare appeals and essential clinical experience. The position offers a competitive pay rate of $36.25 per hour, with potential for transition to a full-time role.

Qualifications

• Three years of relevant experience in healthcare settings.
• Candidate must have RN or LLP license.
• Experience with medical records and appeal decisions.

Responsibilities

• Review medical records and make determinations for disputes.
• Ensure all appeal issues are addressed.
• Conduct research on regulations and policies related to healthcare.

Skills

Medical dispute resolution

Medicare appeals

Clinical experience

Education

Associate's degree in healthcare or related discipline

RN or LLP license

Job description

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Role: Medical Dispute Resolution Specialist, Level III

Location: Fully Remote

Hours: M-F 9 - 5 EST

Contract: 4 months contract to full time hire

Payrate: $36.25/hr and $65,000 salary when converted

Requirements: Must have RN or LLP (License #required)

Experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting.

Must have Hospital experience in ICU, ER, Med-Surge, or PACU

Position Purpose:

Provides dissatisfied patients/beneficiaries and/or providers the opportunity to present documentation to demonstrate why an appeal/dispute should be allowed. Provides an independent second level determination/dispute resolution based on the documentation, facts, laws, regulations, and guidelines.

• Reviews medical records/case file, writes a reconsideration/dispute resolution decision that is clear, concise, and impartial and supports the determination made, and documents review.
• Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, and policy.
• Responds to and ensures that all appeal/dispute issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
• Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
• Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision.
• Stays abreast of changes in regulations, medical and healthcare practices, policies and procedures.

Minimum Qualifications

Education

• Associate's degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline
• Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate’s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)
• RN or LLP required

Experience

• Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or related experience in a healthcare setting
• Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
• Juris Doctorate or Master’s Degree in Healthcare or related discipline may be substituted for Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
• Demonstrated experience writing or making appeal or payment determinations
• Patient- Provider Dispute Resolution, preferred
• Coding certificate, preferred

To read our Candidate Privacy Information Statement, which explains how we will use your information, please visit https://www.modis.com/en-us/candidate-privacy/

The Company will consider qualified applicants with arrest and conviction records.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider and Human Resources

• Industries

  Hospitals and Health Care

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