RN / Case Management Job in Norcross, Georgia
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Description
Standard Qualifications: Parallon, a leading health care company is offering a great opportunity. We are looking for a dynamic candidate to be part of our team. We offer excellent relocation and benefit packages, including 401K, bonus potential, tuition reimbursement, medical and dental plans, flexible spending plans, long-term/ short -term disability, and generous paid time off! DUTIES INCLUDE BUT ARE NOT LIMITED TO: Compose clinical appeal letters to send to payers for denial reconsiderations utilizing documentation, contract language, or voice recordings as applicable Present a concise medical summary within each appeal based on support from the medical record Demonstrate understanding of use of all Medical Necessity software, including but not limited to InterQual© Demonstrate ability to interpret medical payer policy requirements Strong ability to research evidence-based practices Contact appropriate parties (internal and/or external) as needed for additional information to properly formulate the clinical appeal. Determine root cause of each denial and apply company-specific coding for trending and analysis Update the patient account record to identify actions taken on the account Identify problem accounts/processes/trends and escalate as appropriate Complete all required annual training Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement" Other duties as assigned
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