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.
Remote position.
Work hours: Monday - Friday 8:30am to 5:00PM. Additional work schedule: Every 5 weeks Friday coverage is from 9 to 5:30pm
Job Duties
JOB QUALIFICATIONS
Graduate from an Accredited School of Nursing
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
Active, unrestricted State Registered Nursing (RN) license in good standing.
MI RN licensure
PREFERRED EDUCATION:
Bachelors' Degree in Nursing or Health Related Field
PREFERRED EXPERIENCE:
Nursing experience in Critical Care, Emergency Medicine, Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience.
Appeals or claim review knowledge
Must be computer skilled with the ability to navigate between numerous programs at once
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
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.