About Us:
Our culture is based on connection, and that fuels our outstanding performance. At BroadPath we maintain and nourish a commitment to home-based talent and innovative workforce technology that enables us to deliver unrivaled quality, flexibility, and transparency. We believe in meeting our associates where they are, be it in geography or career development. Our proprietary platform visually connects the members of each home-based client team, fully unleashing the skills and motivation of the industry’s best workforce; and enabling our associates to reach their full potential. Today, we provide organizations in healthcare, financial services, travel and hospitality, and high-growth industries with managed, remote teams of skilled professionals to handle key business functions including customer experience, sales, and back-office operations. BroadPath, where connection happens.
Overview:
Innovative, Dynamic, Fast-paced, and Collaborative are just some words our employees use to describe us when they become a part of BroadPath and experience our Culture of Constant Connection! BroadPath is immediately hiring a Registered Nurse to work from home! Our Registered Nurse will be responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims. Ensures that claims are settled promptly and according to cost control standards.
Responsibilities:
- Conduct clinical/medical reviews of retrospective medical claim reviews, medical claims, and previously denied cases to ensure medical necessity and accurate billing and claims processing.
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Identify and report quality of care issues.
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Refer members with special needs to the appropriate Health plan program.
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Assist with Complex Claim reviews, requiring decision-making based on clinical experience.
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Document clinical review summaries, bill audit findings, and audit details in the database.
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Provide supporting documentation for denial and modification of payment decisions.
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Independently re-evaluating medical claims and associated records using advanced clinical knowledge and regulatory guidelines to assess the appropriateness of service provided.
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Collaborate with Medical Directors on denial decisions by reviewing medically appropriate clinical guidelines.
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Serve as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals.
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Resolve escalated complaints regarding Utilization Management and Long-Term Services and support issues.
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Prepare and present cases with the Chief Medical Officers and Medical Directors for Administrative Law Judge pre-hearings, State Insurance Commission meetings, and Meet and Confers.
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Present cases effectively to the Judicial Fair Hearing Officer during Fair Hearings if required.
Qualifications:
- Must have an Active Registered Nurse (R.N.) License
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Must have at least 1 year of Medicare experience
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Must have one of the following in their background
o Utilization Management experience
o Case management
o Prior Authorization experience
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Bachelor’s Degree or equivalent experience
Our Registered Nurse will love the following benefits & perks!
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PAY RATE/SALARY: $35-$40/ Hourly based on experience
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Invitation to join our Inclusivity, Diversity, Equity, + Action Committee
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Access to BroadPath’s Limited Medical Plan starting first of the month after 60 days of employment. After one (1) year of full-time employment, you will receive access to our Major Medical Plan, 401K, and our one of a kind “Bhive Kit;” which includes a camera that allows you to join our Connected Culture!
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Uncapped Employee Referral Program & Weekly Pay
Diversity Statement:
Join us at BroadPath and become a part of a team that values innovation, collaboration, and a commitment to providing exceptional service. If you meet the qualifications and are ready to make a difference in the healthcare industry, we encourage you to apply today!
