For this managed care company the Retro Review Coordinator is responsible for receiving, organizing and submitting clinical information to the Medical Director and/or other physician reviewers for retrospective or reconsideration determinations.
Get to work from home .
New York City managed care company .
The Retro Review Coordinator will:
Receive Macess correspondence and clinical information related to retrospective reviews, reconsiderations and reopening determinations
Manage mail correspondence
Research claims and DRG information in the claims system
Enter all necessary information in the Medical Management software system
Set up physician referrals for medical director and outside physician reviewers
Generate appropriate approval and denial letters for providers and members
Maintain absolute file integrity with regards to content, location and confidentiality
Coordinate onsite reviews by second level physician reviewers for reconsiderations and appeals
2+ years of RN experience
Case management experience in managed care
Strong claims experience
Coding knowledge
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Applicant Category: Professional
Requisition Code: Work at home
Two Initials of Recruiter: bw
System Date: 05/15/2007
System Time: 10:03:56
Document Name(40): Retro Review Coordinator
Source: The New York Times Job Market
SearchTerms: "work at home" "work from home"
URL(80): http://jobs.nytimes.com/texis/jobsearch/details.html?id=464811cb6d60e&q=%22work%
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