Behavioral Health, Clinical Claims Review Nurse (REMOTE – Compact License REQUIRED)

$40.00-$42.00 an hour – Full-time

**Contract Position – Expected Duration Sept-Oct 2024 or LONGER**

Qualifications – Non-Negotiable’s (Please Read!)

• Active Registered Nurse License, Multi-State (AZ Included)
• 2+ Years of Diverse Clinical Behavioral Health Experience (inpatient, outpatient/intense, detox, substance abuse, residential treatment programs)
• 2+ Years of Chart Review Experience from a MCO (Insurance Side-NOT Facility)
• Experience with Behavioral Health Revenue Codes (HCPCS)

Full Job Description

Are you a Registered Nurse that is looking to join a progressive organization that specializes in projects related to Quality Improvement? We are looking to hire a Registered Nurse to support our Claims Review-Behavioral Health functions of both inpatient and outpatient services! This will provide assurance to our members that they are getting the access to treatments they require. Get your career started with us today by applying!

**This position is a contract-temp role that is expected to last through September – No guarantees**

What we provide to you as a full-time teammate:

We offer a competitive benefits package that is on par with most of the leading healthcare organizations, along with a 401K plan. Apply today if you are interested in getting your name in the mix!

Requirements

Summary: The RN will utilize standard criteria to review post-service and prepayment reviews of OP Behavioral Health claims. The nurse will utilize HCPC codes (ex H0004, H2017, S9480, etc) to ensure claims are being charted for correct processing of Arizona Medicaid-AHCCCS requirements.

Essential Duties and Responsibilities: Include the following, other duties may be assigned.

As a Registered Nurse (Medical Claims Reviewer – Behavioral Health), you will…

• Review charts for a specific state Medicaid plan for OP, Behavioral Health and/or SUD + Detox services rendered.
• Analyzing the provider service claims for potential fraud by comparing it to the Medicaid State plan criteria (ASAM and CALOCUS)
• Working with Behavioral Health HCPCs to analyze services documented.
• Conduct clinical assessments and chart reviews, pre-payment and post-service; Did these services actually happen? Were these services done, billed or coded correctly?
• Charts per day = Approx. 12-18
• Utilize a docking system in addition to Microsoft Applications to perform daily tasks.
• Working predominately independently as part of a team of nurses across the country.

Expectations of Performance: The employee in this role shall be considered to be performing in an acceptable manner when carrying out the Core Values:

• Independent
• Adaptability
• Analytical
• Team Player
• Time Management and Efficiency

Education and/or Experience:

• Active Registered Nurse License, Multi-State (AZ Included)
• 2+ Years of Diverse Clinical Behavioral Health Experience (inpatient, outpatient/intense, detox, substance abuse, residential treatment programs)
• 2+ Years of Chart Review Experience from a MCO (Insurance Side-NOT Facility)
• Experience with Behavioral Health Revenue Codes (HCPCS)

Computer Skills: To perform this job successfully, an individual should have knowledge of basic office equipment such as: “EMR” – (electronic medical record system), Microsoft Office, computer, internet, email, copy and fax machines, and telephone.

Benefits:

• 401(k)
• Dental insurance
• Vision insurance
• Medical insurance
• AD&D
• Short and long term disability
• Sick Time
• Critical Illness

Schedule:

• M-F, 8am-5pm (Employees Timezone)
• 32-40 hours per week
• Equipment Provided: Laptop, monitors, cell