Clinical - Appeals Nurse
Clinical - Appeals Nurse
Posted on :
13-10-2024
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Job Description
Job Description:
Job Title: Clinical Appeals Nurse
Duration: 6 months (Possible Extension)
Location: Remote
Shift: Day 5x8Hour (08:00AM 05:00PM)
Job Summary: The Medical Record Retrieval Specialist is responsible for accurately retrieving medical records using Electronic Medical Record (EMR) systems while meeting daily productivity expectations. This role requires attention to detail and the ability to work independently in a remote environment.
Day to Day Responsibilities of this Position:
- Responsibilities include retrieving medical records with clinical accuracy using remote access to Electronic Medical Record Systems while meeting daily productivity expectations.
- Accuracy and productivity rates are closely monitored to maintain a >95% accuracy rate but also to be efficient and productive as compared to their peers.
- Additionally perform RateMax duties including but not limited to medical record review for missed opportunities and provider chase leads claims research and chase activation.
- Complete training and testing in the required timeframe with a satisfactory pass rate.
- Communicate and collaborate with coworkers team leads and manager.
- Follow HIPAA and company guidelines to safeguard PHI and PII
- Utilize company equipment in a private secured at home location using wired cable fiber DSL or BPL internet.
- Additional tasks as delegated by team leads and/or manager.
- HEDIS remote access EMR retrieval.
- Staff conduct a detailed review of Electronic Medical Record Systems via remote access logins to locate documentation applicable to HEDIS Hybrid Measures to determine if the qualityofcare measures as defined by NCQA for that years HEDIS audit can be met.
- Applicable documentation is saved to file using an appropriate file format and electronically uploaded via web browser into the abstraction portal.
Required Skills/Experience:
- Electronic Medical Record (EMR) navigation
- Ability to be productive independently in a remote environment
- Healthcare experience in medical terminology medical record review coding or similar experience
- HEDIS knowledge
- Attention to detail
Employment Type
Full Time
Key Skills
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