Clinical Appeals Educator

Remote, CA 90802

Job Number: 2674

Job Description


CLINICAL APPEALS EDUCATOR – MANAGED RESOURCES

Full Time | Remote | Permanent

Job Overview/Purpose

The Clinical Appeals Educator works under the direction of the Director of Clinical Appeals. The Clinical Appeals Educator will assist in orientation and training of Clinical Nurses, as well as the implementation and execution of department and organizational goals. The Clinical Appeals Educator will maintain regular job duties as a Clinical Appeals Nurse (Appeal writer) to include billable hours dependent on the business needs of the department.

Founded in 1994 Managed Resources (MRI) in Long Beach California, MRI partners with clients nationwide to help them solve complex revenue cycle and compliance challenges.  In our over 25 years of operations, MRI has had the pleasure of working with many of the most prestigious healthcare organizations and medical groups in the county that span from the Hawaiian Islands to the East Coast.  

Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources.

Essential Job Functions:

Complete the following functions in accordance with Managed Resources policies:
  • Develops, produces, and delivers training to Clinical Appeal Nurses on an ongoing basis. This includes new hire training, annual training and on an as needed basis for current employees
  • Maintains department education (Cloud) by reviewing and updating content on a regular basis
  • Serves as a resource and subject matter expert
  • Proactively identified educational deficits and executes training plan
  • Keeps abreast of all regulatory changes pertaining to appeals processes. Advises leadership on best practices. Provides updates to Clinical Appeal leadership team for client education.
  • Assist in QA of Clinical Appeal Nurses as needed
  • Helps maintain Elenchus worklists (Pending Manager, Pending Expert Review) and maintains personal work que
  • Maintain job duties as a Clinical Appeals Nurse (Appeal writer) with billable hours
  • Trouble shoots client access and other computer problems. Identifies problems and recommends solutions
  • Assist in planning and execution of monthly staff meetings
  • Exemplifies the core values of Managed Resources
  • Other duties as assigned

Education & Experience
  • RN with comparable experience and background
  • Past healthcare education experience
  • Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards.
  • Working knowledge of provider billing guidelines, payer reimbursement policies, and related industry- based standards.
  • Working knowledge of billing codes, Revenue Codes, CPT’ s, NCD/LCDs, etc.
  • Working knowledge of federal and state specific healthcare laws and regulations
  • Experience and knowledge of managed care contracts, account receivables and revenue cycle functions.
  • Specific knowledge of managed care denials and underpayment decisions
  • Proficient in Microsoft Office (Word, PowerPoint, OneNote, Excel, etc.)

 

Ideal candidate will possess the following:

 
  • Ability to instruct educational training to varied groups of adult learners in various settings
  • Strong presentation skills with the ability to engage others
  • Ability to navigate resistance to change and solve problems effectively
  • Excellent oral and written communication skills.
  • Possess strong organizational skills and attention to detail.

 

Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO

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