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LPN Nurse Appeals Associate - ...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
New York, NY
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS4470

LPN Nurse Appeals Associate - Pine St., NYC - PS4470

About the Job

Description

Your Talent. Our Vision. At Empire Blue Cross Blue Shield, a proud member of the Anthem, Inc. family of companies, it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.

This Nurse Appeals Associate position is located in the downtown Manhattan office on Pine St. Following training and evidence of ability to work independently, you will be able to work from home 2 days/week. You must have a high speed internet connection to work from home.

The Nurse Appeals Associate is responsible for supporting the development and implementation of quality improvement interventions and audits.

Primary duties may include, but are not limited to:

Researches, collects data, and submits and resolves administrative appeals.

Contributes to external reviews site visit preparations by the State, accreditation review and Quality Management Committee; conducts internal monitoring and audits timeline compliance standards.

Processes, tracks, trends, and reports complaint and grievances issues.

Prepares complaint and grievance files for Fair Hearings and serves as a subject mater expert on complaints and grievances for non-clinical staff.

Participates in quarterly Plan HIPAA audits.

Qualifications

Requires an LPN; 1 year of related experience; or any combination of education and experience, which would require an equivalent background.

-Current, unrestricted LPN license in NY state required.

-Experience working with the appeals process preferred.

-Experience working with Medicaid, managed care preferred.

-Experience in Quality Management preferred.

-Computer skills: MS Word, Outlook, Excel

-Must be detail oriented, organized, able to meet contractual deadlines.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

 

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