Vacancy expired!
RN Clinical Claims Reviewer-REMOTE, prefer ESTLocation: United StatesNewRequisition #: PS34337Your Talent. Our Vision . At Anthem, Inc., 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.RN Clinical Claims Reviewer - REMOTE but within a commutable distance to an Anthem officeRESPONSIBILITIES:RN Post Service Clinical Claims Reviewer in this job reports to
designated manager will be paid hourly and be eligible for overtime.Primary duties may include,
but are not limited to conducting post service clinical claims/disputes reviews
in interpreting appropriateness medical necessity of care of inpatient
admissions, outpatient services, surgical and diagnostic procedures, out of
network services, and appropriateness of treatment setting by utilizing the
applicable criteria, medical policy, and member eligibility, benefits, and
contracts. Responsible to collaborate with medical directors to ensure
appropriate medically necessary determinations, high quality, cost effective
care.REQUIREMENTS:Requires current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States2+ years acute care clinical experience.Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.Strong computer proficiencyPREFERRED:Previous claims/medical record review experience preferredExperience with Macess, Facets, NextGen preferredMay be hired for a Claims Reviewer I/II based on experienceAnEqualOpportunityEmployer/Disability/Veteran
Vacancy expired!