Appeals and Grievances - Work from Home: RCM Technologies

Looking for RN's with Appeals and Grievances experience in Home Care, Managed Care or Acute Care!!!

Appeals and Grievances Clinical Coordinator is responsible for supporting the Manager and Department Coordinators regarding clinical issues. In addition, the A&G Clinical Coordinator is responsible for receiving, investigating and responding in writing, to member appeal and grievances. After successful completion of the training program you will be set up in a home office.

DESCRIPTION:

• Ensure appeals and grievances are categorized and processed within New York State and Federal timeframes.
• Identify potential quality issues and initiate referrals to the Quality Improvement Department.
• Maintain absolute file integrity with regards to content, location and confidentiality.
• Prepare for and participate in regulatory site visits.
• Develop and assist with training for new department employees

SKILL SETS:

• Exceptional written and verbal skills
• Knowledge of the New York State ART 44 PHL and Federal Regulatory environment
• Proficiency in Microsoft Word
• Ability to work both independently and as a team member
• Must meet stringent deadlines and easily adjust priorities among all product lines
• Must be detail oriented and analytical

EXPERIENCE:

• At least two years experience in clinical practice
• Experience in Claims Processing or Member Services in a managed care organization preferred

OTHER REQUIREMENTS:

• Clinical (LPN, RN) required.
• Knowledge of NY State and Federal regulations highly desirable
• Proficiency in Microsoft Office Required

Salary up to $72,000 with solid benefits!!! Chance to work from home

More Information

Telecommute is an option for A&G Clinical Specialist, but the employee has to meet the performance criteria and it usually takes 4 months. The employees will telecommute 4 days a week in the beginning and over time he/she will come in once a month. However, it is a gradual process.

Corporate Office is Downtown

Comprehensive Benefits

23 PTO days (1st yr), 28 PTO days (2nd yr), 8-9 holidays Medical, Dental, Eye Coverage L/T and S/T disability Tuition Reimbursement Pre Tax Spending Plan (child care, transportation, medical exp) Profit Sharing Bonus Plan