Job Posting
Appeals Nurse Analyst
Company: Highmark Medicare Services, Inc.
Location
Job Description:
Highmark Medicare Services, Inc., one of the 100 Best Places to Work in Pennsylvania, is responsible for the combined administration of Medicare Part A and Part B fee-for-service claims for the states of Pennsylvania, Delaware, Maryland, New Jersey and the District of Columbia. Like its parent company, Highmark, Inc., Highmark Medicare Services, Inc. embraces workforce diversity as a means to best serve its increasingly diverse customer base. We were recently recognized as one of the 100 Best Places to Work in Pennsylvania for 2009. By tapping into the different skills, abilities, and perspectives of a diverse workforce, Highmark Medicare Services, Inc. is able to serve and anticipate the needs of a changing and expanding marketplace. We are currently seeking candidates for the following position in Camp Hill, PA:
APPEALS NURSE ANALYST
This position is responsible for the following: Conducting a review of medical documentation to provide a clinical determination on a Part A and/or Part B case file by applying Medicare coding and policies and rendering a first level appeal decision. This position is located in our Camp Hill facility and supports work being conducted in Camp Hill and Williamsport units. The incumbent will work within several computer systems: Standard Medicare Systems (FISS or MCS), Oracle database (Part A), On-line forms. Utilizing advanced computer skills for Internet research and Windows applications. Meeting workload expectations as established by management.
REQUIRED QUALIFICATIONS
• Associates Degree.
• One (1) to three (3) years of experience in clinical decision making.
• Current LPN or RN license.
PREFERRED QUALIFICATIONS
• A Bachelors degree in or equivalent training in Nursing (BSN) or Business Administration is preferred.
• Certification in or equivalent training in Certified Professional Coder, Certified Professional Utilization is preferred.
To submit your resume for consideration, go to the following website: www.highmark.com and click on the Careers link under the About Highmark section of the site. Follow the instructions there to view our current open positions. To apply for this position, use reference #58909. Highmark Medicare Services, Inc., an equal opportunity employer, strives to capitalize on the strengths of individual differences and the advantages of an inclusive workplace. Qualified applicants will receive consideration for employment without regard to race, color, ethnicity, sex, marital status, religion, creed, national origin, disability, veteran’s status, sexual orientation or any other category protected by applicable federal, state or local laws.
Please mention this ad on MinorityNurse.com when applying.
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