Clinical Appeal Nurse Lead - IL/WI Lic Required

Monday through Friday 8:00am to 5:00pm

This is a REMOTE Opportunity.

Pay Range

Government Audit Appeals (Remote SE/MW regions)
Enterprise with IL and WI/NC/GA state license 

Where You Will Work: Remote Government Appeals in MW/SE regions

We’re Looking For:
•    BSN required

• Registered Nurse license issued by the state in which the teammate practices (add Compact State WI/NC and IL
• Extensive knowledge of Government Audits to lead a clinical RN team to produce expert level appeals for denials associated with LCD/NCD and CMS regulatory components. Prior appeal writing for CMS government denials required. Extensive background in hospital and professional claim billing as well as DRG/CPT coding knowledge required. Strong leader and interpersonal skills required to include education/mentoring for ongoing government audits to develop and enhance team skills to effectively defend denials and ensure financial recovery of reimbursements.

What You’ll Do:

• Responsible for training, evaluating and staffing coverage for Revenue Recovery. Performs quality review process audits and staff feedback. Ensures acceptable productivity levels and assigned tasks/appeals are completed
• Identify process inefficiencies and opportunities for daily workflow improvement and participate in developing new processes with Revenue Recovery Manager.
• Keeps abreast of current standards, regulations, and issues related to denials and Revenue Recovery including but not limited to, Government and Insurance Payer reimbursement regulations, clinical practices, utilization management, process improvement and health care industry trends via literature, educational offerings, federal register, etc.
• Maintains an effective working relationship with both internal and external customers.
• Perform clinical denial review and appeals as needed based on coverage needed. Ensure personal and staff productivity goals are met or exceeded.
• Monitors and manages daily reports to ensure timely appeals per payer requirements. 
• Solid knowledge of CMS and other regulatory requirements.
• Solid understanding of process improvement.
• Demonstrated flexibility, teamwork, and system thinking.
• Proven understanding and analyzing claims and medical records.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program