Wilkes-Barre, Pennsylvania, United States · Hybrid
$68k–$95k/yr
Provide timely review and determination of medical claims, including prior authorization, appeals, and/or any other type of medical claims;Provide timely review and determination of medical claims;Analyze medical records…
Skills: Medical Claims Review, Prior Authorization, Medical Record Analysis, Regulatory Compliance, Medical Coding
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
Perform timely review and determination of medical claims, including prior authorizations and appeals, by analyzing medical records. Formulate narrative decisions based on federal regulations, health plan policies, and NCD/LCD guidelines.
Requires a current, unrestricted Registered Nurse (RN) license and at least one year of clinical experience. Proficiency in Medicare regulations and coding guidelines (CPT, HCPCS, ICD-10) is highly preferred.
| ||
work experience requirements | ||
|
FHAS is a trusted leader in dispute resolution, medical claims review, utilization management, and legal adjudication.
Federal Hearings and Appeals Services, LLC (FHAS), a URAC-accredited Independent Review Organization (IRO) and Health Utilization Management (HUM) provider, is a trusted national leader in dispute resolution, medical claims review, legal adjudication, and business process outsourcing. As the industry’s premier Independent Dispute Resolution Entity (IDRE) and a leading Medicare and claims review partner, FHAS leverages nearly 30 years of expertise to deliver fair, accurate, and timely solutions for healthcare providers, payors, federal and state government agencies, and their subsidized programs. Our services deliver clinical precision, regulatory expertise, and personalized solutions to enhance healthcare delivery and resource efficiency. Committed to our clients’ success, FHAS empowers partners with equitable, high-value solutions that strengthen the healthcare ecosystem nationwide.
Offices: 40 Coal St, 2nd Floor, Wilkes-Barre, Pennsylvania 18702, US · 117 West Main Street, Plymouth, Pennsylvania 18651, US · 1 PPG Place, 31st Floor, Pittsburgh, Pennsylvania 15222, US · 177 East Colorado Boulevard, Pasadena, California 91105, US
FHAS is a trusted leader in dispute resolution, medical claims review, utilization management, and legal adjudication.
Federal Hearings and Appeals Services, LLC (FHAS), a URAC-accredited Independent Review Organization (IRO) and Health Utilization Management (HUM) provider, is a trusted national leader in dispute resolution, medical claims review, legal adjudication, and business process outsourcing. As the industry’s premier Independent Dispute Resolution Entity (IDRE) and a leading Medicare and claims review partner, FHAS leverages nearly 30 years of expertise to deliver fair, accurate, and timely solutions for healthcare providers, payors, federal and state government agencies, and their subsidized programs. Our services deliver clinical precision, regulatory expertise, and personalized solutions to enhance healthcare delivery and resource efficiency. Committed to our clients’ success, FHAS empowers partners with equitable, high-value solutions that strengthen the healthcare ecosystem nationwide.
Offices: 40 Coal St, 2nd Floor, Wilkes-Barre, Pennsylvania 18702, US · 117 West Main Street, Plymouth, Pennsylvania 18651, US · 1 PPG Place, 31st Floor, Pittsburgh, Pennsylvania 15222, US · 177 East Colorado Boulevard, Pasadena, California 91105, US
