Medical Review and Appeals Coordinator/RN
Your ability to analyze, evaluate and give voice to your observations is critical to our patient care
You have an exceptionally calm, logical vision paired with the practical knowledge and depth of experience to make consistently fair appeals determinations. Plus, your understanding of the complexities of the process along with your ability to communicate sensitive issues to others would make you an ideal candidate for this important role at Bergen Regional Medical Center.
In this position, you will be responsible for the day-to-day management of Denial and Appeals Processes, analyzing and reviewing prospective appeals for reconsideration of denied charges. You will also identify and communicate quality of care concerns as they relate to the care that has or has not been provided by the documented healthcare team.
This is another critical area where your insights will be sought and highly valued.
To qualify, you must have:
● A Bachelor’s degree in Nursing or a related field
● Current NJ RN license
● Certification in Case Management, Certification in Psychiatric/Mental Health Case Management preferred
Required experience includes:
● Five years working for a health insurance company, HMO or hospital processing health care claims
● Ten years of clinical experience in an acute care setting with at least 5 years in Behavioral Health
Other necessary skills include:
● Personal computer knowledge including Microsoft Office, Word and Excel
● Working knowledge of InterQual Criteria, Medicare/Medicaid and managed care coverage guidelines
● Capacity to interpret and apply clinical guidelines to determine coverage based on contractual benefits
● Exceptional ability to interact with a wide range of individuals via spoken and written word
● Proven ability to independently analyze pertinent information and make decisions
To learn more about Bergen Regional Medical Center and to apply for this exciting opportunity, visit our website to To learn more about Bergen Regional Medical Center and to apply for this exciting opportunity, visit the job posting.