Medical Necessity Appeals Manager (Rn)

Fulltime | Remote | Permanent

Managed Resources is a leading consulting group assisting healthcare organizations nationwide in optimizing its revenue cycle management through review, recovery and educational programs. Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources!

Purpose:

The Medical Necessity Appeals Manager (RN), will work in conjunction with the Director of Clinical Appeals. The Manager will oversee the daily operations of a Clinical Appeals team and will assist in the planning, implementation, and execution of department and organizational goals. The Medical Necessity Appeals Manager (RN) is directly involved in assuring the timeliness and quality of work produced by the staff. The
Medical Necessity Appeals Manager (RN) will serve as a client liaison and will be directly involved in client deliverables, statistical reporting, and client education.

Reports to:

Director of Clinical Appeals

Essential Job Functions:

Complete the following functions in accordance with Managed Resources policies:

• Leads a team of Clinical Appeal staff who pursue denials on behalf of Managed Resources Clients
• Provides support to Clinical Appeals staff and serves as a resource and subject matter expert
• Conduct reviews and assists in feedback to the Clinical Appeals Nurse
• Monitors productivity and quality standards of the Clinical Appeals Nurse
• Conducts yearly evaluations of direct reports; provides feedback with opportunities for improvement on a continuum throughout the year
• Assist in staff work assignments as needed
• Assist is client deliverables: Data gathering, denial trends and knowledge gaps, case examples and follow ups from client meetings.
• Helps maintain Elenchus worklists (Pending Manager, Pending Expert Review) and maintains personal work que
• Assists with recruiting, interviewing, and training of employees; Identifies educational opportunities and knowledge gaps and constructs performance improvement plans as needed
• Develops and maintains strong working relationships with other leaders and provides cross coverage as needed
• Trouble shoots client access and other computer problems. Identifies problems and recommends solutions.
• Advises key management on process and system enhancement opportunities
• Provides feedback to Director on operational concerns and oversight of team members
• Assist in planning and execution of monthly staff meetings
• Exemplifies the core values of Managed Resources
• Other duties as assigned.

Ideal candidate will possess the following:

• RN with comparable experience and background.
• Proven leadership skills including ability to provide necessary oversight to team members.
• Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards.
• Working knowledge of billing codes, Revenue Codes, CPT’s, NCD/LCDs, etc.
• Experience and knowledge of managed care contracts, account receivables and revenue cycle functions.
• Working knowledge of provider billing guidelines, payer reimbursement policies, and related industry- based standards.
• Specific knowledge of managed care denials and underpayment decisions.
• Excellent oral and written communication skills.
• Proficient with Microsoft Office (Word, Excel, PowerPoint)
• Ability to work independently in a fast-paced environment.
• Ability to interact with management personnel and clients.
• Possess strong organizational skills and attention to detail.
• Ability to multi-task and meet multiple deadlines.

Check Out Our Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance
• Pet Insurance
• Monthly Internet Stipend

Our Vision:To become the most trusted, innovative and consultative revenue cycle partner in the nation.

Visit http://jobs.managedresourcesinc.com to find more jobs and sign up for job alerts.
Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO

Job Type: Full-time

Pay: $88,000.00 - $110,000.00 per year

Schedule:

• Day shift

Work setting:

• Remote

Experience:

• Leadership: 3 years (Required)
• Writing appeals: 4 years (Preferred)

Work Location: Remote