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Job Requirements of Clinical Review Clinician - Appeals:
-
Employment Type:
Full-Time
-
Location:
Columbus, OH (Onsite)
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Clinical Review Clinician - Appeals
Pyramid Consulting, Inc
Columbus, OH (Onsite)
Full-Time
Immediate need for a talented Clinical Review Clinician - Appeals. This is a 06+ Months Contract opportunity with long-term potential and is located in Columbus, Ohio (Onsite). Please review the job description below and contact me ASAP if you are interested.
Job ID:25-68236
Pay Range: $30 - $34/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy .
#prof J2W:CB3
Job ID:25-68236
Pay Range: $30 - $34/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Perform appeal review for medical necessity, complete appeal cases (making determination, documenting outcome, sending out letter, and closing out appeal in system).
- Behavior and accountability and ability to pivot when new priorities come up)
- Determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.
- Emails and Team chats to ensure communication is reached and assistance is available, if needed.
- Skills-RN, Utilization management and Appeals,
- Experience with Utilization Review/Management--2 yrs.
- Reviews relevant information within denied authorization/prior authorization case to ensure a complete case summary is provided to the Medical Director for review of the appeal case.
- Review medical code data and records to determine whether a denial is warranted.
- Utilizing multiple appeals/claims systems to conduct medical reviews.
- Comfortable with Microsoft office programs and utilizing systems to input medical criteria.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy .
#prof J2W:CB3
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