Clinical Appeals Nurse Specialist - Asturias, España - Nezda Technologies

Descripción

• Access account from appropriate work queue and mark account worked to make sure it will not be assigned to another reviewer
• Review activity summary, documentation, and correspondence to obtain notes related to the denialo Review for additional information, such as insurance card, face sheet, detailed bill, Explanation Of Benefits, UB04, auth approval, denial letter
• Review claim and billing history to isolate any denials related to coding, billing, timely filing, missing or incorrect information
• Identify root cause of the denial
• Work on Medical Necessity and No Authorization denials , and Untimely filing only
• Review medical records and obtain necessary information to support medical necessityo ER, H&P, Physician Orders, Consulatations, Operative Report, Coding Summary, Discharge Summary, Labs, Radiology, MAR, Outside Medical Records, Nurses Notes
• Apply contract language, benefits and covered services in researching and deciding the outcome of appeals
• Upload and send the letter to the correct fax number/address or Portal
• Document activity in the client systems Your application will include the following questions: What's your expected monthly basic salary? How many years' experience do you have as a Nurse Specialist? Report this job advert Don't provide your bank or credit card details when applying for jobs. Researching careers? Find all the information and tips you need on career advice. #J-18808-Ljbffr