Healthcare Quality Strategies
Appeals Professional/Dispute Resolution Review - Sarasota
Healthcare Quality Strategies, Orlando, Florida, us, 32885
Appeals Professional/Dispute Resolution Review - Sarasota
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Appeals Professional/Dispute Resolution Review - Sarasota
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Healthcare Quality Strategies, Inc. (HQSI) This position is a full-time, remote role based in Florida, offering a salary of $75,000 annually. The role involves reviewing healthcare claims appeals, providing independent dispute resolutions, and working under general supervision. Essential Responsibilities
Review medical records and case files, write clear and impartial decisions, and document reviews. Make independent decisions based on medical evidence, regulations, and policies. Respond to issues raised by beneficiaries, providers, and other stakeholders. Conduct research using federal regulations, medical literature, and other resources to ensure accurate decisions. Stay updated on changes in healthcare regulations and practices. Participate in meetings, workgroups, and special projects as assigned. Qualifications
Current, unencumbered LPN or RN license from an accredited institution. Minimum of 5 years clinical experience, including 3 years in healthcare claims processing, utilization review, or medical coding. Experience with Medicare appeals and medical review preferred. Skills and Abilities
Research techniques, medical terminology, understanding of healthcare rules and regulations. Proficiency in Microsoft Office (Excel and Word). Strong decision-making, communication, and organizational skills. Physical Demands
Ability to work in an office setting, sit for prolonged periods, and operate office equipment including a computer keyboard. Healthcare Quality Strategies, Inc. is an Equal Opportunity Employer and provides various employee benefits. For immediate consideration, apply via the HQSI Careers Page. #J-18808-Ljbffr
Join to apply for the
Appeals Professional/Dispute Resolution Review - Sarasota
role at
Healthcare Quality Strategies, Inc. (HQSI) This position is a full-time, remote role based in Florida, offering a salary of $75,000 annually. The role involves reviewing healthcare claims appeals, providing independent dispute resolutions, and working under general supervision. Essential Responsibilities
Review medical records and case files, write clear and impartial decisions, and document reviews. Make independent decisions based on medical evidence, regulations, and policies. Respond to issues raised by beneficiaries, providers, and other stakeholders. Conduct research using federal regulations, medical literature, and other resources to ensure accurate decisions. Stay updated on changes in healthcare regulations and practices. Participate in meetings, workgroups, and special projects as assigned. Qualifications
Current, unencumbered LPN or RN license from an accredited institution. Minimum of 5 years clinical experience, including 3 years in healthcare claims processing, utilization review, or medical coding. Experience with Medicare appeals and medical review preferred. Skills and Abilities
Research techniques, medical terminology, understanding of healthcare rules and regulations. Proficiency in Microsoft Office (Excel and Word). Strong decision-making, communication, and organizational skills. Physical Demands
Ability to work in an office setting, sit for prolonged periods, and operate office equipment including a computer keyboard. Healthcare Quality Strategies, Inc. is an Equal Opportunity Employer and provides various employee benefits. For immediate consideration, apply via the HQSI Careers Page. #J-18808-Ljbffr