ROLE AND RESPONSIBILITIES

• The Appeals Coder/CV Nurse will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department’s/company’s guidance.
• The Appeals Coder/CV Nurse will complete their case within the time expectations while providing high quality reviews. The Appeals nurse will perform their job functions, adhering to both Optum and OPAS policies and procedure.

Your role is critical in allowing our members, families, facilities and health professionals to have greater confidence in the exceptional care we provide. And for you, an everyday opportunity to do your life’s best work.

JOB QUALIFICATIONS

• Active PHRN License and Medical Coding License (AAPC or AHIMA)
• Strong Clinical Knowledge base with a minimum of 3 years of C...