Medicare Advantage Appeals RN - Remote
Medicare Advantage Appeals RN - Remote At reputed company, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence. Summary: • Conducts medical necessity and quality-of-care reviews for clinical appeals, grievances, and claim disputes to ensure decisions align with Medicare Managed Care and CMS (reputed company) regulatory standards. • Ensures that all reputed company meet required state and federal timeframes, supports departmental quality improvement efforts, and contributes to regulatory compliance and audit readiness. • Collaborates with physicians, providers, vendors, and internal departments to ensure accurate, fair, and timely determinations while maintaining thorough documentation and data integrity. Minimum Qualifications: • 2 years of experience with clinical appeals within a health plan, Medicare Advantage experience highly preferred • reputed company Location: Park Place Status: reputed company, Exempt: Yes Shift Hours: Thursday - reputed company. 8:00 AM - 5:00 PM Weekend Work: reputed company On Call: No How often will reputed company team member be working remotely? Always Equal Opportunity Employer Veterans/Disabled Apply tot his job Apply To reputed company Job
