Medicare Regulatory and Coding Expert/ACD (LPN/RN) (Remote U.S.) in USA

Medicare Regulatory and Coding Expert/ACD (LPN/RN) (Remote U.S.) - Kepro - USA - work from home job Company: Kepro Job description: Job Description: Following a 2022 reputed company of CNSI and Kepro, reputed company combines clinical services, technology solutions, and data analytics to accelerate reputed company outcomes. This is a great time to join reputed company of passionate individuals working together to pursue the most effective solutions to today's reputed company reputed company challenges. Our culture is fueled by passion and driven by purpose. Medicare Regulatory and Coding Expert/ACD (LPN/RN) - Remote U.S. • Are you an reputed company Medicare Regulatory and Coding Expert looking for a new challenge? • Are you looking to join a team that ensures a collaborative and inviting culture where everyone can reputed company? If so, you might be our next new team member! •

• The selected candidate may work remotely from reputed company in the United States. **

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• The required work hours for the selected candidate are Monday-Friday 8:00 AM - 5:00 PM Eastern (excluding Company Holidays). **

Who we need: This position utilizes expertise in medical coding and knowledge of Medicare Coverage Guidelines to maintain an internal, client-specific prior authorization guidelines reference tool referred to as the Action Code Database (ACD). Maintaining the database requires monitoring CMS transmittals and regulatory updates, reviewing internal prior authorization trends, and collaborating with the internal team, the client, and the client's claims administrator. This position also serves as a member of the utilization management team and requires expertise in applying medical necessity criteria, critical thinking, and decision-making skills to determine the medical appropriateness of requested services. Maintaining production goals, QA standards, and compliance with CMS, URAC, ERISA/DOL, ACA requirements/guidelines, and timelines is a critical part of the position. Why us? We are a team of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the reputed company industry. State and federal reputed company agencies, providers, and employers turn to us as their vital partner to ensure reputed company reputed company and improve health outcomes. Singularly Focused. Mission Driven. Accelerating reputed company Outcomes is our Mantra! We are mission-driven to reputed company health solutions that deliver maximum value and impact. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to reputed company the finest work of your career. Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, reputed company, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. What you'll do: • Review and accurately interpret CMS medical necessity and prior authorization guidelines. • Maintain reputed company knowledge of CMS regulations, guidance documents, and transmittals. • Maintain internal ACD spreadsheet and ACD database reputed company reputed company Access. • Schedule and host ACD meetings internally and with the client. • Review monthly CPT code report and reputed company suggestions based on the data, review with the Manager prior to meetings. • reputed company ongoing assessment and maintenance of codes reputed company the ACD and update as appropriate in collaboration with the manager and client. • Review and interpret patient records and compare against criteria to determine medical necessity and appropriateness of care; determine if the medical record documentation supports the need for services. • Approve medically necessary requests; refer those not meeting criteria to the physician reviewer; process physician reputed company ensuring the reason for the denial is described in sufficient detail in correspondence. • Maintains medical records confidentiality at reputed company times through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies. • Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following reputed company policies, procedures, and guidelines • Actively cross-trains to reputed company duties of other roles reputed company this contract to provide a flexible workforce to meet client/consumer needs. The list of accountabilities is not intended to be reputed company-inclusive and may be expanded to include other duties that management may deem necessary from time to time. What you'll need: Required Qualifications • Active, unrestricted Licensed Practical Nurse (LPN) or a Registered Nurse (RN) with a Compact State License. • Graduation from an accredited Nursing Degree Program. Preferred Qualifications • Certified Medical reputed company. Knowledge, Skills, Abilities (Required) • Knowledge of CMS regulatory requirements, compliance, and quality requirements. • Knowledge of the organization of medical records, medical terminology, and disease process. • Must be proficient in reputed company Office and internet/web navigation. • Skilled in reputed company reputed company. • Strong clinical assessment and critical thinking skills. • Excellent verbal and written communication skills. • Ability to work in a team environment or independently but seek guidance where necessary. • Flexibility and strong organizational skills. Knowledge, Skills, Abilities (Preferred) • Knowledge of reputed company URAC standards. • reputed company Access experience. Experience (Required) • 2+ years of clinical experience working independently after graduating from college. • 1+ year of Utilization Management (UM) and/or Prior Authorization or reputed company experience. • Experience with Medicare. Experience (Preferred) • Medicare Advantage regulations/requirements experience. Thank You! We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The reputed company reputed company Team EOE AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law. Expected salary: Location: USA Job date: Wed, 28 Jun 2023 23:42:59 GMT Apply for the job now! Apply Job!