Specialist, Clinical Review and Appeals (RN)
Join Our Life-Saving Team today and take advantage of sign-on bonus of up to $7,500!
Are you ready to elevate your career to new heights? PHI Health is looking for dynamic, driven individuals to join our team. We are committed to providing top-tier emergency medical services with unmatched speed and efficiency, saving lives when every second counts. By supporting our mission from the ground, you will play a crucial role in orchestrating the seamless operations that keep our advanced fleet soaring and our patients safe.
With PHI Health you’ll collaborate with the best minds in the industry, driving initiatives that enhance our services and expand our reach to those who need it most. If youre passionate about making a difference and thrive on challenges, PHI Health offers an extraordinary opportunity to impact lives and develop your professional career in a meaningful way.
Who We Are:
PHI Health is the leading air ambulance provider in the United States. With an unmatched safety record and the best aviation, medical and communication specialists in the field, we set the standard in the air medical industry. We transport more than 22,000 patients each year from our more than 80 bases across the country, all while offering services and outreach education to local communities and leading healthcare systems. Our mission is simple: move communities to health while maintaining the highest standard of safety, period.
Position Overview:
Under the direction of the PFS Manager, the Specialist, Clinical Review and Appeals will review and address appeal requests for air ambulance transport that were denied for reasons such as medical necessity and prior authorization. Working in the Patient Financial Services NSA division, this position utilizes its clinical expertise to write clinical appeals.
Job Summary:
- Review and process appeal letters related to medical necessity for denied air ambulance transport claims submitted to insurance companies.
- Collaborate with clinical field staff to resolve documentation issues and ensure all necessary information is collected for appeals.
- Conduct thorough reviews of clinical documentation and medical records to determine medical necessity and appropriateness of care.
- Communicate with hospitals to obtain appropriate medical records required for thorough appeal processing.
- Partner with patient advocacy teams to assist patients in understanding and exercising their appeal rights regarding adverse benefit determinations.
- Ensure compliance with federal, state, and payer-specific regulations and guidelines throughout the review and appeals process.
- Monitor trends in denials and appeals, identify areas for process improvement, and participate in quality assurance initiatives.
- Request and organize supporting documentation to accompany various clinical applications from multiple departments, including but not limited to air ambulance clinical crew.
- Perform other duties as assigned.
Compensation and Benefits
Schedule/Location
The Successful Candidate Will Have:
- Active and unrestricted Arizona Registered Nurse (RN) or Licensed Practice Nurse (LPN) license
- 3+ years of clinical experience as an RN or LPN.
- Air Ambulance, Critical Care or Emergency Room experience preferred
- Prior experience in medical claims/appeals writing preferred.
- Must be able to independently prioritize and process a high volume of work.
- Must have excellent communication skills as the training of staff on the complexity of payer and regulatory requirements is required.
- Maintain the highest level of confidentiality at all times in accordance with HIPAA guidelines and PHI, Inc. and PHI Air Medical, L.L.C. policies.
- Adhere to all PHI, Inc. and PHI Air Medical, L.L.C. policies and procedures.
- Demonstrate responsiveness and sense of urgency when dealing with payers and internal customers.
- Demonstrated expertise in MS Office suite software.
- This position is designated Safety Sensitive for purposes of the Arizona Medical Marijuana Act.
Our Core Competencies:
Safe. We are absolute in our belief in the tenets of Destination Zero and that Zero is not only achievable, but the only acceptable outcome.
Efficient. We are focused on outcomes that are smart and responsible by making the best use of our resources to maximize overall productivity and achieve sustainable profitability as a high performing organization.
Quality. We are committed to ensuring excellent organizational performance which produces sustainable and reliable outcomes.
Service. We are dedicated to the service of our customers, our communities and each other.
The PHI Health Advantage
For more than 40 years, our company has been providing critical air medical transport services across the country. As an organization, we outfit each aircraft we fly with the most advanced technology, subject our crews to the most rigorous protocols and training and pioneer the most-forward thinking safety program in the country.
Everything that we do comes back to the safety of our crew and our patients. Our accident rate is well below the national average and we were the first to receive the Vision Zero Aviation Safety Award. This belief has guided us towards a number of industry firsts and has given us the highest safety rating in the industry.
Take advantage of sign-on bonus of up to $7,500!DISCLAIMER
The above Statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed, as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
PHI, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws
