5 Clinical Review Specialist - Remote | WFH Jobs in Washington, DC
Get It Recruit - Healthcare is Hiring a Remote Clinical Review Specialist - Remote | WFH
HoursThis is initially a part-time position (15 hours per week) with the potential to transition to full-time based on workload and availability.
ResponsibilitiesReview various types of hospital documentation including medical records, UB-04s, EOBs, itemized bills, and hospital account notes.
Utilize TimeMatters to manage work assignments and communicate claim notes effectively.
Interpret medical records and claim documentation to formulate appeals for denied insurance claims related to inpatient and outpatient services.
Apply clinical knowledge and judgment to assess medical necessity, admission criteria, and other clinical reviews.
Draft, review, and revise appeal letters ensuring clarity, logic, and compliance with guidelines.
Ensure all required attachments are included with each appeal and verify page number citations align with the medical record.
Handle high-priority cases within designated deadlines.
Submit appeals, follow-ups, and other documentation within timely filing periods.
Adhere to HIPAA and other regulatory compliance standards.
Contribute to the development of clinical training materials and participate in training sessions for other staff members.
Required QualificationsBachelor's degree from a four-year college or university.
Licensed as a Registered Nurse (RN, APRN, CRNP), Nurse Practitioner (CNP, LNP, NPC), Physician Assistant, Physician, or another qualified healthcare provider.
CompensationActive licensure is preferred but not required.
Compensation starts at $45 per hour depending on qualifications.
Eligibility for monthly bonuses after 90 days of employment.
Potential benefits package including 401k, health insurance, disability insurance, and commuter benefits upon transition to full-time status.
Employment Type: Part-Time
Job Summary
Part Time
$94k-113k (estimate)
06/24/2024
07/19/2024
The following is the career advancement route for Clinical Review Specialist - Remote | WFH positions, which can be used as a reference in future career path planning. As a Clinical Review Specialist - Remote | WFH, it can be promoted into senior positions as a Branch Review Team Lead that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Clinical Review Specialist - Remote | WFH. You can explore the career advancement for a Clinical Review Specialist - Remote | WFH below and select your interested title to get hiring information.
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