Clinical Claims Nurse

Akkodis

United States

Remote

USD 75,000 - 80,000

Full time

14 days+

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Benefits offered by this job

Medical, dental, vision insurance

401K plan

Paid Sick Leave

Job summary

Akkodis is seeking a Clinical Claims Nurse for a remote position. This role involves reviewing documentation to evaluate appeals and disputes, requiring strong analytical skills and a healthcare background. Ideal candidates will have an Associate’s degree or higher and a nursing license, with at least three years of relevant experience.

Qualifications

Minimum of three years’ experience in medical appeals or related healthcare environment.
Background in Nursing, Physical Therapy, Occupational Therapy, or Respiratory Therapy is required.
Possession of a coding certification is a plus.

Responsibilities

Analyze medical records and case files to produce clear summaries for dispute resolution.
Exercise independent judgment to make evidence-based decisions.
Conduct detailed research utilizing online resources to support accurate decisions.

Skills

Analytical Skills

Judgment

Communication

Education

Associate’s degree or higher in a healthcare-related field

LPN or RN License

Job description

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This range is provided by Akkodis. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$30.00/hr - $30.25/hr

Direct message the job poster from Akkodis

Resource Development Manager at Modis(An Adecco Group Company)

Job Title: Clinical Claims Nurse (Healthcare Provider)

Job Type: 4-month Contract to Hire

Location: Remote, United States

Salary Range: $36.25 an hour

Hours: Core Hours M-F, 9-3 PM EST

Position Overview:

This role supports individuals such as patients, beneficiaries, and healthcare providers by reviewing submitted documentation to evaluate the validity of appeals or disputes. It involves delivering a fair and unbiased second-level decision based on an in-depth analysis of facts, supporting documentation, applicable laws, and relevant guidelines.

Key Responsibilities:

Analyze medical records and case files to produce clear, objective reconsideration or dispute resolution summaries that justify the final determination.
Exercise independent judgment to make evidence-based decisions in alignment with legal statutes, established regulations, policies, and clinical standards.
Address and respond thoroughly to all issues presented by patients, beneficiaries, authorized representatives, or healthcare providers involved in the appeal or dispute.
Render impartial conclusions supported by current evidence, policy, and regulatory frameworks.
Conduct detailed research utilizing online resources such as federal regulations, medical standards, policy manuals, and clinical literature to support accurate, well-informed decisions.
Stay informed of developments in healthcare practices, legal regulations, and organizational policies to ensure decisions remain compliant and current.

Required Qualifications:

Education:

Associate’s degree or higher in a healthcare-related field from an accredited institution.
LPN or RN License

Experience:

Minimum of three (3) years’ experience in medical appeals, dispute resolution, clinical review, or a related healthcare environment.
Background in Nursing, Physical Therapy, Occupational Therapy, or Respiratory Therapy is required.
Candidates holding a Juris Doctorate or a Master’s in a healthcare-related discipline may substitute this requirement.
Proven ability to compose or assess appeals and payment-related determinations.
Preferred experience with patient-provider or independent dispute resolution processes.
Possession of a coding certification is a plus.

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

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

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

The California Fair Chance Act

Los Angeles City Fair Chance Ordinance

Los Angeles County Fair Chance Ordinance for Employers

Seniority level