JOB DESCRIPTION
Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers. We are seeking a Registered Nurse with Appeals or claim review knowledge. Must be computer skilled with the ability to navigate between numerous programs at once. Able to work independently in a high-volume environment meeting metric production. Michigan RN license required. Further details to be discussed during our interview process. Work hours: Monday - Friday 8:30am to 5:00PM. Additional work schedule: Every 5 weeks Friday coverage is from 9 to 5:30pm Graduate from an Accredited School of Nursing Active, unrestricted State Registered Nursing (RN) license in good standing. Bachelors' Degree in Nursing or Health Related Field Nursing experience in Critical Care, Emergency Medicine, Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience. Must be computer skilled with the ability to navigate between numerous programs at once Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in Healthcare Quality or other healthcare certification. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.Remote position.
Job Duties
JOB QUALIFICATIONS
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
MI RN licensure
PREFERRED EDUCATION:
PREFERRED EXPERIENCE:
Appeals or claim review knowledge
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: