Healthcare Claims Examiner, RN Required

Claims SpecialistClaims SpecialistFull TimeRemoteTeam 10,001+Since 1954H1B SponsorCompany SiteLinkedIn

Location

North Carolina

Posted

20 days ago

Salary

$60.4K - $81.7K / year

Professional Certificate2 yrs expEnglish

Job Description

• Evaluate appropriateness of beneficiaries' admission to nursing facilities • Verify documentation of medical necessity for prior approval requests • Meet performance expectations by completing at least 40 prior approval reviews daily • Achieve quality assurance reviews with greater than 95% accuracy • Complete timely reviews within 24 hours

Job Requirements

  • Active North Carolina Registered Nurse license or Compact license
  • At least 2 years of clinical experience
  • Knowledge of Microsoft Office and Outlook
  • Experience with medical documentation review
  • Knowledge of NCTracks and business processes of North Carolina Division of Medicaid preferred
  • Clinical medical, surgical and nursing facility experience preferred
  • Clinical research experience preferred

Benefits

  • Variety of medical plan options
  • 401(k) plan with company match
  • Full flex work weeks where possible
  • Paid time off including vacation, sick and personal time, and holidays
  • Paid parental, military, bereavement and jury duty leave
  • 15 days of paid leave per calendar year
  • 10 paid holidays per year
  • Paid Family Leave program
  • Short and long-term disability benefits
  • Life and accidental death and dismemberment insurance
  • Critical illness and travel accident insurance

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