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ProAssets LLC

Registered Nurses

Certificates : Evidencia de estudios (Mandatory)

Division/Department : Enfermeria

Skills : Strong problem-solving skills in fast-paced environments, Customer service, Interpersonal communication, Attention to detail

Experience : 2 Years

Reports to : Marjorie Flores

Shift type : FullTime   |  Salary type : Exempt

  

2 years ago

Date : 06/05/2023

Job Description :

We are looking for a Registered Nurse (RN) with FL license

Location: Aguadilla, PR

Requirements:

  • Minimum Associate Degree in Nursing completed or preferably Bachelor's Degree.
  • Puerto Rico Active RN license and in Florida Active RN license.
  • Previous experience in clinical nursing.
  • Processes documentation and approval.
  • Fully Bilingual (Oral and Written)
Responsibilities:
  • Responsible for accurate and timely processing of healthcare claim service request and processing claims
  • Reviews, evaluates the service request as per SOP
  • Familiar with Medical Policy, Familiar with Clinical service requests, correspondence inquiries and image review
  • Forward the cases to appropriate teams, post the in-scope activities have been completed as per SOP (Standard operating Procedure)
  • Prep medical records for clinical review
  • End to end processing and resolution of clinical claims and correspondence
  • Understand/interpret medical terminology including clinical notes and reports
  • Able to review medical policies and determine the appropriate claim processing or clinical review process decisions (pay, request additional records, refer for clinical review)
  • Review and determine pricing for clinical claims in accordance with negotiated pricing agreements
  • Adept knowledge of verifying member benefits, eligibility verification and medical necessity determination
  • To apply clinical judgement in lines of applicable guidelines while they provide post service Medical
  • Necessity Determination (MND) reviews for Claim Policy business area led by reputed US Payer organization/s
  • To work in collaboration with Medical Directors to deliver top quality medical necessity determination services to clients

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