Job Description and Tasks:
Candidates will have to manage their workload, perform under pressure, and work well with the rest of the team.
- Quickly and efficiently review medical records and submit well-written appeals to health insurers and governmental payers.
- Be comfortable, skilled, assertive, cordial, and professional on the telephone to follow up on submitted appeals.
- Navigate through various computer systems and applications to find information about insurance claims.
- Apply clinical standards to determine appropriate level of care
- Provide feedback to colleagues and clients in a constructive, positive, friendly, and affirming manner
- Either a BS in Nursing OR an MD
- GPA of 3.0 or higher
- Proficiency in Microsoft Office, including Word and Excel
- Highly attentive to detail
- Excellent organizational and time management skills
- Clear, concise, and logical writing style
- Exemplary people skills
- Prior experience in a clinical setting (e.g. hospital, doctor’s office, outpatient facility)
- Familiarity with clinical standards (e.g. Milliman Care Guidelines, InterQual Criteria)