Clinical Review Nurse

🔥 12 hours ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Ternium Revenue Cycle Management

WebsiteLinkedInAll Job Openings

11 - 50 employees

🛡️ Insurance

⚖️ Legal

🏥 Healthcare

Insurance • Legal • Healthcare

Ternium Revenue Cycle Management is a specialized consulting service focused on improving healthcare revenue cycles. With over 50 years of combined experience, the founders have worked with some of the largest healthcare providers in the country, offering bespoke solutions for complex accounts and insurance denials. The company emphasizes quality of work and collaboration with their clients to achieve superior results in accounts receivable management and overall revenue cycle performance.

📋 Description

• Analyze denied insurance claims and complete medical records. • Apply clinical reasoning, national criteria (InterQual/Milliman), and best practices to determine if appeals are justified. • Draft persuasive, medically sound appeal letters that clearly support the need for treatment or services. • Collaborate with our legal team to ensure appeals are compelling and complete. • Stay informed on healthcare regulations, payer trends, and clinical updates.

🎯 Requirements

• RN License (required) • 5+ years of acute hospital experience (required) • Certification in Case Management, Legal Nurse Consulting, or Coding is a plus. • Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards • Experience and knowledge of managed care contracts, account receivables and revenue cycle functions (preferred) • Experience and success in medical record chart review and appealing managed care denials (preferred).

🏖️ Benefits

• 401(k) with corporate match • Comprehensive health, dental, and vision insurance. • Flexible schedule and paid time off. • Access to professional development, mentorship, and upward mobility within a thriving company. • Life insurance and performance-based bonuses.