Iselin, New jersey
Appeals Clinican Position - Remote Job Opening in Iselin, New jersey - Appeals Clinician Position - Remote
Essential Duties and Responsibilities:
Performs retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials.
Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization.
Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appeal process.
Demonstrates proficiency in utilization of electronic tools including but not limited to Microsoft Office.
Minimum Qualifications & Competencies:
Must possess a valid nursing license (Current, valid RN/LPN/LVN licensure)
Minimum of 5 years recent acute care experience with the last 2 years in a facility environment
care experience preferred
Minimum of 2 years UR/Case Management experience within the last 2 years
Managed care payor experience a plus either in Utilization Review, Case Management or Appeals
Patient Accounting experience a plus
About Aergo:
/ Aergo Solutions is a leading full-service provider of technology products and services for the healthcare provider community. Founded in 1994, the company's focus has been developing, implementing and supporting its proven, cost-effective solutions in provider revenue-cycle operations. Aergo Solutions was founded on the notion that traditional Revenue Cycle systems lack the robust workflow and analytical tools necessary to run a Revenue Cycle in today's challenging environment. Since 1993, Aergo has developed highly effective products and services all based on our proprietary Escort technology platform.
Job Type: Contract
Required experience:
UR/Case Management: 5 years
acute care in Facility, care: 5 years
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