Location: Patchogue,NY, USA
Carewise Health helps organizations improve the personal health of employees and control healthcare costs. Our industry-leading health and wellness programs help members build the skills they need to achieve and sustain optimum health. Medical Bill Review ensures that health plans and self-insured employers are billed accurately for the care their members receive. Headquartered in Louisville, KY.
NOTE
Potential to be a remote position based on progression after the first 90 days.
Pay will be based on experience. Range from $62,000 to $66,000.
-Screens referred claims by reviewing the diagnosis, procedures, length of stay, areas of charges, patient age, type of bill, state regulations, customer expectations, and historical information for the facility.-Route claims to appropriate product.-Meet prescreen deadlines.-Update facilities in the system as appropriate.-Develop a working rapport with customers by responding to inquires in a timely manner with tact and understanding.-Maintain effective communication with team members.-Maintain open communication.-Generate production reports of screen claims.-Other duties as assigned.
Carewise Health provides a generous benefits package including:
Medical InsuranceDental InsuranceLife InsuranceVision InsurancePaid VacationPaid HolidaysPaid Sick DaysShort Term DisabilityLong Term Disability401K Plan With Company MatchTuition ReimbursementEmployee Assistance Program
All benefits are effective on the first day of employment with the exception of tuition reimbursement and STD/LTD, which is effective after 90 days of employment.
Attention Staffing Agencies: This position is not open for agency submittals. Any candidate submitted without HR approval will be considered an applicant of Carewise Health, not the agency. All Agency Candidates must first be submitted to HR.
EOE Disability/Veterans
Required Skills
-Diploma in nursing required (Associate or Bachelor's degree in nursing preferred). Can be a RN or a LPN
-Must have an active & unrestricted registered nurse license in the state of employment or reciprocal state.-Minimum of three years clinical hospital experience.
-Healthcare claim audit experience must be demonstrated
-Healthcare claim knowledge strongly suggested in the following areas: Medical Necessity, High Cost Specialty $ NOC Infusions, High-cost Implants & Supplies, One Day Admissions, Readmissions, ER Visits, End Stage Renal Disease and HAC/Never Events
-Considerable knowledge of CMS claim reimbursement regulations a plus
-Experience with payment platforms Facets, FEP and NASCO a plus
-Coding experience a plus-Must have excellent verbal and written communication skills.
-Must be proficient in Microsoft Word and Microsoft Outlook.
-Must be detailed oriented.-Must be able to work with deadlines.-Must have ability to organize and prioritize competing duties.
-Proficient typing skills.
-Must be able to successfully complete any required pre-employment testing.
-Travel required for company, client or provider meetings
Required Experience
Qualifications: -Diploma in nursing required (Associate or Bachelor's degree in nursing preferred). Can be a RN or a LPN
-Must have an active & unrestricted registered nurse license in the state of employment or reciprocal state.-Minimum of three years clinical hospital experience.
-Healthcare claim audit experience must be demonstrated
-Healthcare claim knowledge strongly suggested in the following areas: Medical Necessity, High Cost Specialty $ NOC Infusions, High-cost Implants & Supplies, One Day Admissions, Readmissions, ER Visits, End Stage Renal Disease and HAC/Never Events
-Considerable knowledge of CMS claim reimbursement regulations a plus
-Experience with payment platforms Facets, FEP and NASCO a plus
-Coding experience a plus-Must have excellent verbal and written communication skills.
-Must be proficient in Microsoft Word and Microsoft Outlook.
-Must be detailed oriented.-Must be able to work with deadlines.-Must have ability to organize and prioritize competing duties.
-Proficient typing skills.
-Must be able to successfully complete any required pre-employment testing.
-Travel required for company, client or provider meetings