Remote Nurse Reviewer - Appeals & Hearings

Gainwell Technologies LLC; Ohio; A distancia; USD 69.000 - 99.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

401(k) employer match

Comprehensive health benefits

Educational assistance

Generous flexible vacation policy

Descripción de la vacante

Gainwell Technologies is seeking a Nurse Reviewer Appeals and Hearing to coordinate and perform all appeal-related duties, analyze and respond to provider appeals, and prepare case files for hearings. The role requires an unrestricted RN license in the United States and 5+ years of clinical or coding experience.

You will review appeals, ensure documentation is complete, and participate in hearings, with remote work as default and up to 25% travel for onsite hearings.

Formación

• Unrestricted RN license in the United States (incl. multistate license if applicable).
• 5+ years of clinical or medical record coding experience.
• 3+ years in utilization review or claims auditing with knowledge of appeals/hearings process.

Responsabilidades

• Coordinate and perform all appeal-related duties including analyzing and responding to provider appeals.
• Review documentation to ensure all aspects of the appeal are addressed properly and accurately.
• Prepare case files and case summaries for hearings and participate in hearings (virtual and on-site).
• Assist management with training new reviewers and provide mentoring/education.

Conocimientos

RN license

Clinical experience

Utilization review

Medical coding

Attention to detail

Herramientas

MCG guidelines

InterQual guidelines

Descripción del empleo

Gainwell Technologies is seeking a Nurse Reviewer Appeals and Hearing to coordinate and perform all appeal-related duties, analyze and respond to provider appeals, and prepare case files for hearings. The role requires an unrestricted RN license in the United States and 5+ years of clinical or coding experience.

You will review appeals, ensure documentation is complete, and participate in hearings, with remote work as default and up to 25% travel for onsite hearings.