Nurse Reviewer, Appeals and Hearings Specialist
3 weeks ago
At Gainwell Technologies, we're seeking a talented Nurse Reviewer, Appeals and Hearings Specialist to join our team. This role is a great opportunity to leverage your medical expertise and analytical skills to make a meaningful impact in the healthcare industry.
Key Responsibilities:- Review and analyze provider appeals and redeterminations using approved clinical and coding guidelines.
- Prepare case files and summaries for hearings, and actively participate in virtual and on-site hearings.
- Collaborate with the Medical Director to ensure accurate and timely appeal determinations.
- Assist in training new reviewers, including mentoring, feedback, and education.
- Maintain current knowledge of clinical criteria guidelines and coding standards.
- Active, unrestricted RN licensure from the United States and the state of primary home residency.
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) certification preferred.
- 5+ years of clinical experience or 5+ years of medical record coding experience preferred.
- Excellent written communication skills and ability to write clear, concise, and accurate rationales.
- A competitive salary range of $64,000 to $80,000 per year.
- A comprehensive benefits package, including health, dental, and vision insurance, and a 401(k) employer match.
- A generous, flexible vacation policy and opportunities for professional growth and development.
We're committed to creating an inclusive and diverse workplace where everyone has the opportunity to thrive. If you're passionate about making a difference in healthcare and have the skills and experience we're looking for, we encourage you to apply for this exciting opportunity.
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