Healthcare

RN Clinical Editing Analyst

Contract

Strategic Staffing Solutions

STRATEGIC STAFFING SOLUTIONS HAS AN OPENING!

Strategic Staffing Solutions (S3) is currently looking for a RN Clinical Editing Analyst for a contract opening with one of our largest clients working in Detroit, MI

 

This is a Contract Opportunity with our company that MUST be worked on a W2 ONLY, NO C2C eligibility for this position.  The details are below.

RN Clinical Editing Analyst

SUMMARY:

Review all appeals focused on medical necessity including review of all documentation, contact with providers,

interaction with related corporate departments such as medical directors and other follow-up activities.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  1. Process appeal requests related to clinical editing based on medical necessity; handle resolution of other

clinical edits such as multi-surgery, daily limit processing, member eligibility, verification of claim validity,

submission of required documentation and appeal timeframes in accordance with departmental

procedures.

  1. Maintain required documentation including logs and databases, Macess, FACETS entries, Care Advance,

letter generation, etc. related to appeals and inquiries as appropriate.

  1. Analyze reports, appeals and inquiries related to clinical edits, daily limit processing and other related

clinical editing activities. Resolve issues identified on reports.

  1. Coordinate with medical consultants to resolve appeals that require their intervention; document resolution

in accordance with established processes.

  1. Resolve internal inquiries to ensure consistent application of clinical editing criteria.
  2. Assist in resolution of other coding, clinical editing, and policy related issues, including but not limited to

review of cases submitted with not otherwise classified codes (NOC).

  1. Other duties as assigned.

EDUCATION AND/OR EXPERIENCE

  1. Current valid and unrestricted Michigan RN license. BSN preferred.
  2. Certified professional coder designation (for example CPC).
  3. Five (5) years clinical experience in a health care setting as a practicing registered nurse.
  4. Two (2) years’ coding, billing, or auditing/record review experience as a professional coder.

Qualifications:

  •  RN License
  • Claims experience
  • medical billing or coding or medical auditing or Review specialist

How to Apply:  send resume and contact information to Genecee Lopez, Sourcing Specialist, at GLopez@strategicstaff.com

 The S3 Difference:

The global mission of S3 is to build trusting relationships and deliver solutions that positively impact our customers, our consultants, and our communities. The four pillars of our company are to:

  • Set the bar high for what a company should do
  • Create jobs
  • Offer people an opportunity to succeed and change their station in life
  • Improve the communities where we live and work through volunteering and charitable giving

As an S3 employee, you’re eligible for a full benefits package that may include:

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • 401(k) Plan
  • Vacation Package
  • Life & Disability Insurance Plans
  • Flexible Spending Accounts
  • Tuition Reimbursement

 

 

 

 

 

 

 

Job ID: JOB-216973
Publish Date: 20 Jan 2023

Tagged as: RN Clinical Editing Analyst