Medical Review Clinical Appeals Auditor, RN – SNF/MDS

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BASF

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Chemicals • Agriculture • Healthcare

BASF is a global chemical company that operates across multiple sectors, providing a wide range of products and solutions. The company is focused on innovation and sustainability, serving industries such as agriculture, automotive, construction, electronics, energy, and healthcare. With a commitment to research and development, BASF aims to create chemicals that enhance the quality of life and support sustainable practices worldwide.

10,000+ employees

Founded 1865

🌾 Agriculture

📋 Description

• Conduct Appeals reviews of new evidence presented by auditees • Objectively and accurately document Appeals results according to department quality policies • Review audit documentation and conduct research, analyze claims data • Monitor, track, and report on all work conducted in accordance with Appeals process • Contribute to the continuous improvement feedback process and audit results • Support training material/tools and best practices development

🎯 Requirements

• Active unrestricted RN license in good standing • At least 5+ years relevant experience in a provider or payer environment • Strong technical aptitude and intermediate to advanced skills using Excel • One or more years of experience in health care claims including ICD-9/ICD-10 coding • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or similar.

🏖️ Benefits

• medical, dental, vision, HSA/FSA options • life insurance coverage • 401(k) savings plans • family/parental leave • paid holidays • paid time off annually