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Key Responsibilities:
- Conduct appeals reviews on medical review audit work.
- Document and route appeal outcomes accurately.
- Analyze claims and regulations to support findings.
Skills Needed:
- ICD-10, CPT/HCPCS, MS-DRG coding.
- MCG/InterQual and utilization management.
- Advanced Excel and reporting.
Qualifications:
- Active RN license with 5+ years MDS/SNF experience.
- Healthcare claims, billing, or utilization review experience.
- Prior audit, QA, or appeals experience preferred.
Machinify
Machinify is a healthcare intelligence company offering an AI-powered platform for health plan payment and clinical review. It serves over 85 health plans and over 270 million lives, with a culture of innovation and continuous improvement.