RN Appeals Coordinator

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1948

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Arkansas Blue Cross and Blue Shield is a health insurance provider licensed to offer health plans in all 75 counties of Arkansas. The company offers a wide range of insurance products including individual and family plans, Medicare and Medigap plans, dental and vision plans, as well as health plans for travelers and employer group plans. They provide members with personalized services such as health management through the Blueprint Portal, where users can manage their health plan, review claims, find healthcare providers, and estimate treatment costs. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

📋 Description

• Review appeal cases for diagnosis codes and medical necessity • Provide comprehensive responses according to medical practice standards, corporate medical policy, code review logic, contractual guidelines, and regulatory requirements • Collaborate with medical divisions on legal issues related to benefits • Explain medical coverage policy application • Respond to the Arkansas Insurance Department and other state insurance departments regarding complaints and appeals within legally required timeframes • Practice nursing within the scope of licensure • Make evidence-based decisions to ensure compliance, appropriate level of care, and patient safety • Remain current on medical and surgical procedures, products, healthcare services, drugs, healthcare delivery trends, enterprise procedures, policies, and contracts • Perform other duties as assigned • Report to Senior Counsel

🎯 Requirements

• Bachelor's degree in Nursing preferred • Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required • Minimum five (5) years' clinical nursing experience, including a broad background in various facets of nursing • Minimum two (2) years' experience in utilization review, medical policy, and/or case management required • Knowledge of HCPCS/CPT/Revenue codes and general coding principles • Knowledge of claims processing rules/logic • Knowledge of Health Plan operations, regulatory agencies, and State/Federal regulations related to health care • Previous experience in appeals and/or grievances process preferred • Excellent oral and written communication skills • Detail-oriented • Strong analytical, critical thinking, organizational, and time management skills • Proficiency in Microsoft Office, including Word, Excel, Outlook, and PowerPoint; ability to navigate multiple systems and keyboarding • Ability to make sound judgments and decisions based on facts and guidelines • Ability to build collaborative relationships • Ability to work independently with little supervision • Ability to interpret complex documentation • Must maintain security and confidentiality of records and information • Must adhere to segregation of duties guidelines • Must practice nursing within the scope of licensure and comply with applicable regulations and standards

🏖️ Benefits

• Remote work arrangement • Regular employment • Periodic campus travel within walking distance of the primary work assignment • Ability to work remotely or in an office setting