Appeals Clinician

Aergo Solutions LLC - Iselin, NJ

ContractEstimated: $59,000 - $80,000 a year
Skills

Aergo Solutions is the partner of choice to healthcare providers in support of their Revenue Cycle challenges. We solve problems through a customized mix of services, consulting and technology that can change over time to meet any client’s evolving needs.

We work with 300+ providers in 25+ states and bring a client-focused approach that makes each provider feel like our only client. Aergo offers the following products and services; A/R Services, Denials Recovery, Pre-Registration, Managed Care Consulting, Contract Management, and Revenue Cycle Workflow.

We are currently looking for an Appeals Clinician to work remotely for our company.

Essential Duties and Responsibilities:

  • Performs retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials.
  • Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization.
  • Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appeal process.
  • Demonstrates proficiency in utilization of electronic tools including but not limited to Microsoft Office.

Minimum Qualifications & Competencies:

  • Must possess a valid nursing license (Current, valid RN/LPN/LVN licensure)
  • Minimum of 5 years recent acute care experience with the last 2 years in a facility environment
  • Medical-surgical/critical care experience preferred
  • DRG downgrades and/or coding experience is preferred
  • Minimum of 2 years UR/Case Management experience within the last 2 years
  • Managed care payor experience a plus either in Utilization Review, Case Management or Appeals
  • Patient Accounting experience a plus

Equal Opportunity Employer

Job Type: Contract