Appeals Nurse, Certified Coder

Blue Cross Blue Shield of MA

Hingham, Massachusetts, US
Base: $41.72 - $50.99 hourly; bonus/equity: eligib...
Review provider appeals for denied services
Apply nursing judgement to medical necessity
Utilize coding guidelines cpt icd-10 hcpcs
The role facilitates, coordinates, and responds to provider appeals for denied services utilizing extensive clinical and regulatory knowledge

Job Summary

  • The role facilitates, coordinates, and responds to provider appeals for denied services utilizing extensive clinical and regulatory knowledge.
  • Employees are eligible for a comprehensive package of benefits including paid time off, medical/dental/vision insurance, and 401(k).
  • The company is committed to creating an inclusive workplace that promotes excellence and provides opportunities for employees to forge their unique career path.

Matching Summary

The role facilitates, coordinates, and responds to provider appeals for denied services utilizing extensive clinical and regulatory knowledge.

Salary

Base: $41.72 - $50.99 hourly; Bonus/Equity: Eligible for variable pay; Benefits: Comprehensive package including PTO, medical/dental/vision, 401(k)

Skills & Requirements

Must-have

  • Review provider appeals for denied services
  • Apply nursing judgement to medical necessity
  • Utilize coding guidelines CPT ICD-10 HCPCS

Nice-to-have

  • Excellent organizational and prioritization skills
  • Ability to problem solve independently
  • Collaborate with physician review units

Key Requirements

  • Registered Nurse with current Massachusetts licensure
  • Credentialed coder (CPC or CCS) required
  • Minimum 3-5 years acute care experience
  • BSN preferred

Work Rights

Not specified

Tailored Resume

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