Clinical Review Nurse at Valenz Health

Valenz Health

Medical Evaluate Nurse

Absolutely Distant Distant Employee

Job Kind



Valenz Well being simplifies the complexities of self-insurance for employers via a steadfast dedication to knowledge transparency and choice enablement powered by its Healthcare Ecosystem Optimization Platform. Providing a robust basis with deep roots in medical and member advocacy, alongside a long time of experience in declare reimbursement and cost validity, integrity, and accuracy, in addition to a collection of threat affinity options, Valenz optimizes healthcare for the supplier, payer, plan, and member. By establishing true transparency and providing data-driven options that enhance price, high quality, and outcomes for employers and their members, Valenz engages early and sometimes for smarter, higher, sooner healthcare.

About Our Alternative

As a Medical Evaluate Nurse for our Invoice Evaluate group, you’ll pre-screen claims to make sure that providers rendered are medically mandatory and acceptable. Day by day, you’ll audit claims figuring out medical errors, overpayments, and/or experimental and investigational gadgets primarily based on accepted billing and plan coverage exclusions and share findings with our negotiation group.

Issues You’ll Do Right here:

  • Establish right billing and financial savings on claims by working the codes via applications.
  • Collaborate with the Negotiation group to resolve declare points and procure financial savings by making use of corrected claims, letters of settlement, or different documentation mandatory.
  • Finalize IRO (Unbiased Evaluate Group) financial savings by figuring out financial savings, requesting plan paperwork, medical data, create submission, finalize report.
  • Take part in shopper evaluate calls appearing as a Topic Matter Professional within the medical invoice evaluate house.
  • Consider and reply to invoice reconsideration requests.
  • Maintains a constant division invoice evaluate prescreen turnaround time. Normal TAT for Invoice Evaluate pre-screen 24 hours from UB/IB receipt.
  • Companions with friends and administration within the formulation and documentation of division processes and insurance policies, interdepartmental resolutions, and system enhancements.
  • Assists direct supervisor in achievement of departmental objectives and strategies that may improve income regarding Invoice Evaluate.
  • Complies with/helps HIPAA requirements.

Cheap lodging could also be made to allow people with disabilities to carry out important duties.

What You’ll Deliver to the Crew:

  • 3+ years of expertise in auditing, claims, invoice evaluate, or case administration.
  • 2+ years of expertise in a medical setting in medical surgical, crucial care, or equal.
  • Present BSN, RN, or MSN.
  • Working data of trade coding and pointers, ICD-10, CPT, HCPCS and Income codes, CMS pointers, and so on.
  • Robust aptitude for relationship constructing with a extremely efficient communication fashion.

A plus when you’ve got:

  • Expertise with RevCycle Professional/or Encoder Professional/or SuperCoder.
  • Data of Investigative /Experimental critiques, HCD, implant repricing, degree of care critiques, DRG critiques.
  • CPC or CIC Certification
  • Medical health insurance expertise

The place You’ll Work

This position is distant.

Why You Will Love Working Right here

We provide worker perks that transcend normal advantages and compensation packages see beneath!

At Valenz, our group is dedicated to delivering on our promise to have interaction early and sometimes for smarter, higher, sooner healthcare. We would like everybody engaged inside our ecosystem to be sturdy, vigorous, and wholesome. You’ll discover limitless development alternatives as we develop collectively. In the event you’re able to make the most of your abilities and keenness to make a big affect within the healthcare self-funded house, Valenz is likely to be the right place for you!

Perks and Advantages

  • Generously sponsored company-sponsored medical, dental, and imaginative and prescient insurance coverage
  • Firm-funded HRA
  • 401K with firm match and rapid vesting
  • Versatile working setting
  • Beneficiant Paid Time Off
  • Paid maternity and paternity depart
  • Paid firm holidays
  • Neighborhood giveback alternatives, together with paid day off for philanthropic endeavors

At Valenz, we have a good time, help, and thrive on inclusion, for the advantage of our associates, our companions, and our merchandise. Valenz is dedicated to the precept of equal employment alternative for all associates and to offering associates with a piece setting freed from discrimination and harassment. All employment selections at Valenz are primarily based on enterprise wants, job necessities, and particular person {qualifications}, with out regard to race, colour, faith or perception, nationwide, social, or ethnic origin, intercourse (together with being pregnant), age, bodily, psychological or sensory incapacity, HIV Standing, sexual orientation, gender id and/or expression, marital, civil union or home partnership standing, previous or current navy service, household medical historical past or genetic data, household or parental standing, or some other standing protected by the legal guidelines or rules within the places the place we function. We won’t tolerate discrimination or harassment primarily based on any of those traits.

To assist us monitor our recruitment effort, please point out in your cowl/motivation letter the place ( you noticed this job posting.

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