Appeals Nurse

Job Title: Appeals Nurse
Job Location:  Remote
Job Duration: 5 Months (Potential to Extend)
 

Responsibilities: Responsibilities include retrieving medical records with clinical accuracy using remote access to Electronic Medical Record Systems while meeting daily productivity expectations.   Accuracy and productivity rates are closely monitored to maintain a >95% accuracy rate, but also to be efficient and productive as compared to their peers. Additionally, perform RateMax duties including, but not limited to, medical record review for missed opportunities and provider chase leads, claims research, and chase activation. Complete training and testing in the required timeframe with a satisfactory pass rate. Communicate and collaborate with coworkers, team leads and manager. Follow HIPAA and company guidelines to safeguard PHI and PII Utilize company equipment in a private, secured, at home location using wired cable, fiber, DSL or BPL internet. Additional tasks as delegated by team leads and/or manager. HEDIS remote access EMR retrieval. Staff conduct a detailed review of Electronic Medical Record Systems via remote access logins to locate documentation applicable to HEDIS® Hybrid Measures to determine if the quality-of-care measures, as defined by NCQA for that year’s HEDIS® audit, can be met. Applicable documentation is saved to file using an appropriate file format and electronically uploaded via web browser into the abstraction portal.
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:				Preferred Skills/ Experience:
1.	Electronic Medical Record (EMR) navigation			1.	HEDIS Project experience
2.	Ability to be productive independently in a remote environment			2.	Experience abstracting data from medical records
3.	Healthcare experience in medical terminology, medical record review, coding, or similar experience			3.	Experience in QSHR or working with copy service vendors
4.	HEDIS knowledge			4.	Ability to adapt to changing priorities in managing a wide range of projects.
5.	Attention to detail			5.	Remote Access EMR record retrieval
Education Requirement:		Associate’s degree or relevant 2+ years’ medical and HEDIS experience		Education Preferred:		Bachelor’s degree RN
Software Skills Required:		Microsoft Suite – Word, Excel, Teams, Outlook, OneNote, and PPT
Required Certifications:				Required Testing:		Testing on HEDIS Measures

 

About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
 
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
 
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
 
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer. 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $47.89/hr.