Review clinically related denials, payer audits, and payer correspondence.
Prepare appeal submissions and audit responses using clinical expertise and critical thinking.
Evaluate medical records against appropriate criteria and contract requirements to support or defend denied claims.
Serve as a liaison to revenue cycle, case management, and practice stakeholders to help reduce denials and identify prevention opportunities.
Associate degree required.
Minimum of 3 years of relevant nursing experience.
Current active unrestricted RN license required.
Preferred experience includes:
- ICD-10-CM/PCS coding conventions
- DRG reimbursement methodology
- Clinical validation principles
- Coding Clinic guidance and Medicare IPPS regulations
- Utilization review, case management, denials and appeals, revenue cycle, or prior authorization
- Medicaid and Medicare claims denials and appeals
- Medical policy and Medicare LCD/NCD criteria
- Milliman Care Guidelines and InterQual Criteria
- NCQA/URAC standards
- 2-Midnight Rule criteria
- Epic
- Microsoft Office Suite and basic data entry
Strong communication, organization, problem-solving, and analytical skills required.
Medical: Multiple plan options.
Dental: Delta Dental or reimbursement account for flexible coverage.
Vision: Affordable plan with national network.
Pre-tax savings: HSA and FSAs for eligible expenses.
Retirement: Competitive retirement package.
Location
Minnesota, US
Employment Type
Contractor
Experience Level
Senior
Salary Range
$88,358 - $123,780
Remote work allowed
Yes
Posted
3 weeks ago