Appeals Nurse (LPN)

Christian Care Ministry•Melbourne, FL

17d•$25 - $34•Onsite

About The Position

The Appeals Nurse (LPN) is responsible for supporting the Appeals/Grievances function by explaining the membership voted guidelines and utilizing your medical knowledge to guide members through the appeals process. The LPN will also complete tasks for gathering and obtaining all needed information for the appeal such as medical records, provider letters, etc. The responsibility of the Appeals Nurse (LPN) is to work collaboratively with members of the team to provide the needed support in communicating with members and providers to obtain needed information and explain the appeal process and status.

Requirements

Understand diversity of systems and workflows as they relate to the type of review or assignment
Ability to multitask in multiple operating systems
Ability to work for extended periods of time on the computer
Ability to be objective and impartial
Ability to de-escalate difficult conversations
Ability to communicate effectively with both internal and external customers
Possess ability to adapt to changing processes
Working knowledge and application of program guidelines
Ability to practice good interpersonal skills and work as a member of a team
Ability to work autonomously to prioritize and manage workload
Knowledge in the use of the internet including e-mail and search engines
Word processing and keyboard skills of at least 25 wpm
Basic knowledge in Microsoft Office (Excel, Word, Outlook)
Ability to use a database system, including how to update fields
Knowledge of a document imaging system
LPN license required with sound knowledge of anatomy and physiology and disease processes required

Nice To Haves

Experience in medical record clinical reviews or appeal/grievances within a healthcare payer organization preferred

Responsibilities

Answer member questions about medical records, how they apply to their bills, and the appeal process
Communicate with members and/or providers what is needed for case review preparation and delivery of determination status
Organize and ensure we have all needed medical records, lab results, and radiological reports, etc.
Learn and maintain an understanding of Medi-share program guidelines and appeals processing functions
Acquire medical records for appeals from providers
Keep members informed of the appeal process and pray with them
Coordinate the next steps in the appeal process when necessary
Set up the next level of appeals for members
Be a point of contact for member while in appeals process
Maintain workflow follow up in various queues
Document medical correspondence received from members and providers following approved processes
Receive inbound and place outbound calls from/to members and providers
Help to maximize cost savings by referring cases to other departments, as needed
Assist with overflow from Appeals Admin; such as obtaining medical records, help with conclusion letters, contacting members or help any way with overflow and coverage
Work autonomously to prioritize and manage workload
Comply with all organizational HIPAA requirements
Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
All other duties as assigned

Benefits

100% paid Medical for employees/99% for family
Generous employer Health Savings Account (HSA) contributions
Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
6 weeks of paid parental leave (for both mom and dad)
Dental - two plans to choose from
Vision
Short-term Disability
Accident, Critical Illness, Hospital Indemnity
401(k) – up to 4% match on ROTH or Traditional contributions
Generous paid-time off and 11 paid holidays
Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
Employee Assistance Program including no cost, in-person mental health visits and employee discounts
Monetary Anniversary Awards Program
Monetary Birthday Awards