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Behavioral Health Claims Reviewer RN

3 months ago

Phoenix, United States Medix™ Full time

Behavioral Health RN - Utilization Review - FULLY REMOTE POSITION

MUST HAVE ARIZONA OR COMPACT RN LICENSE

MUST HAVE UM/UR Experience with Managed Care Organizations


Medix Healthcare

Phoenix, AZ 85016

Monday-Friday 8am-5pm

$40.00-42.00 hour - FULL TIME


Job Details

Hourly

$40.00-42.00 (Hourly)

Job Type

Full-Time


Qualifications

  • Arizona RN or Compact Multistate RN License
  • 2+ Years of Behavioral Health Experience (Inpatient, Outpatient, Acute Care)
  • ASAM & CALOCUS Understanding
  • Chart Review Experience (Utilization Management, Levels of Care, OP Services, HCPCs Codes)
  • Microsoft Office Experience (Excel, Word, Teams)


Benefits

For your Health...

  • Medical, Dental, and Vision Insurance
  • Employer-Paid Basic Life Insurance/AD&D
  • Voluntary Employee-Paid Life Insurance/AD&D
  • Employer-Paid Short Term and Long Term Disability
  • Employee Assistance Program
  • Wellness Program

For your Wealth...

  • HSA and FSA Options
  • 401k Retirement Plan with Company Match

For your Wealth...

  • Paid Time Off
  • Travel Assistance Program


Full Job Description


Are you looking to advance your career in healthcare? We are currently hiring for a FULLY REMOTE Behavioral Health Claims Review RNs to support a large healthcare organization in Phoenix. Apply to get your name in the mix and join our industry movement

What we provide to you as a full-time teammate:

We offer a competitive benefits package that is on par with most of the leading healthcare organizations. Apply today if you are interested in getting your name in the mix


Essential Duties and Responsibilities:

As a Behavioral Health Claims Review RN you will…

  • This project is specifically aligned with AZ Medicaid-AHCCCS and CMS.
  • Issues were noticed last year in regards to Behavioral Health services being billed and serviced incorrectly for AHCCCS patients.
  • Phoenix itself is not only the 5th most populated US city, but we have a huge tribal community presence; at least five that surround the city, and all of these patients are on AHCCCS - In addition to a very high frequency of Mental Health, Substance Abuse/Detox services.
  • The purpose of this position is to review AHCCCS claims, both prepayment and post-service, to identify if the claim is essentially fraudulent or not. Did these services actually happen? Were these services done, billed or coded correctly?
  • Will be utilizing a lot of AHCCCS specific programs in addition to Microsoft Office apps (i.e. Excel)
  • Claims per day is approx 12-18, this could vary day by day but is the average
  • Working on a team with a Director and Associate Project Director (both nurses) who have been with HSAG for many years. Team also has many other nurses working this project from all across the US
  • Role is a contract/project due to the fact that HSAG has a contract with AHCCCS directly through at least December of 2024. There is a chance it can get extended, but no guarantees. (If it does get extended, it would most likely be for another year)


Supervisory Responsibilities: This position has no supervisory responsibilities.


Expectations of Performance: The employee in this role shall be considered to be performing in an acceptable manner when carrying out the Core Values:

  • Independent
  • Detail Oriented
  • Integrity
  • Positive Attitude


Education and/or Experience:

  • Arizona RN or Compact Multistate RN License
  • 2+ Years of Behavioral Health Experience (Inpatient, Outpatient, Acute Care)
  • ASAM & CALOCUS Understanding
  • Chart Review Experience (Utilization Management, Levels of Care, OP Services, HCPCs Codes)
  • Chart Review Experience
  • Microsoft Office Experience (Excel, Word, Teams)


Nice to Have Skills

  • Remote Work Experience


Soft Skill/Attribute Requirements

  • Strong work ethic
  • Ability to Focus in Remote Environments


Computer Skills: To perform this job successfully, an individual should have knowledge of basic office equipment such as: “EMR (electronic medical record system), Microsoft Excel computer, internet, email, copy and fax machines, and telephone.


Work Environment: This position is going to be FULLY REMOTE.

Job Type: Full-time

Pay: $40.00-42.00/hourly

Benefits:

  • 401k
  • Dental insurance
  • Health insurance
  • Life insurance
  • Sick Time/Paid Time Off
  • Vision insurance

Schedule:

  • Monday-Friday 8am-5pm

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