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Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Empire Blue Cross Blue Shield, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve. Note: This position supports Medicaid appeals for the New Jersey health plan. This position is remote/work at home, but candidate must currently reside in the Eastern region on EST. The Nurse Appeals Associate is responsible for supporting the development and implementation of quality improvement interventions and audits. Primary duties may include, but are not limited to:
Researches, collects data, and submits and resolves administrative appeals.
Contributes to external reviews site visit preparations by the State, accreditation review and Quality Management Committee; conducts internal monitoring and audits timeline compliance standards.
Processes, tracks, trends, and reports complaint and grievances issues.
Prepares complaint and grievance files for Fair Hearings and serves as a subject mater expert on complaints and grievances for non-clinical staff.
Participates in quarterly Plan HIPAA audits.
Qualifications
Requires an LPN; 1 year of related experience; or any combination of education and experience, which would require an equivalent background.
Current, unrestricted LPN license.
Experience working with the appeals process preferred.
Experience working with Medicaid, managed care preferred.
Experience in Quality Management preferred.
Intermediate computer skills preferred (a computer skills test may be required).
Must be detail oriented, organized, able to meet contractual deadlines.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and
is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit
us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
REQNUMBER: PS37091
Vacancy expired!