layiq

/la·yiq/adjective

worthy; deserving; fitting; suitable.

A role, opportunity, or path that merits attention, time, and pursuit.

CLINICAL APPEALS ANALYST (ON-SITE) at Riverside Healthcare | LAYIQ

Benefits - .5 to 1.0 FTE

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Benefits - .001 to .49 FTE:

Paid Leave Hours accrued as you work
Employee Health Requirements
Exposure/Sensory Requirements
Exposure to: Chemicals: Refer to MSDS manual
Video Display Terminals: Average
Blood and Body Fluids: Diagnostic composite of patients, frequent contact with intravenous devices, and high potential for contact with contaminated body fluids (blood, vomitus, stool) and administration of blood does create a high risk. Use of needleless IV system, universal precautions and protective equipment minimize risk..
TB or Airborne Pathogens: Patient diagnostic presentations do pose high risk. Usage of protective wear and universal precautions minimize risk.
Sensory requirements (speech, vision, smell, hearing, touch): Speech: Required to communicate with patient/families/staff/doctors, coworkers, ancillary personnel and other department heads. Ability to ask for help.
Vision: Required to perform necessary assessments of patient status, medication administration, CIS usage, and reading active orders and lab reports.
Smell: Helpful to note presence of incontinence, vomitus, blood; electrical/fire safety.
Hearing: Necessary to hear alarms, calls for help and to hear patient verbalizations. Necessary to hear lung, bowel and heart sounds. Needed to hear alarms (i.e., fire, codes via PA system).
Touch: Necessary to perform percussive assessments and to comfort patients. Also needed to manipulate tools and equipment.
Activity/Lifting Requirements
Percentage of time during the normal workday the employee is required to: Sit: 10%
Twist: 4%
Stand: 40%
Crawl: 0%
Walk: 25%
Kneel: 1%
Lift: 10%
Drive: 0%
Squat: 1%
Climb: 1%
Bend: 30%
Reach above shoulders: 3%
The weight required to be lifted each normal workday according to the continuum described below:
Up to 10 lbs: Frequently
Up to 20 lbs: Frequently
Up to 35 lbs: Frequently
Up to 60 lbs: Occasionally
Up to 75 lbs: Not Required
Up to 100 lbs: Not Required
Over 100 lbs: Not Required
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting patients off their beds that are unable to move independently is done with assistive lifting equipment. Horizontal movement of patients to and from carts/beds who are unable to move independently is done with assistive lifting equipment. Lifting equipment - carry 25'- 150' waist high (IV bags, patient trays, charts). Filled laundry bags are filled half full so as not to weigh over 35#. Carry fire extinguishers up/down 3-4 flights of stairs and several yards in emergency.
Maximum consecutive time (minutes) during the normal workday for each activity: Sit: 30
Twist: 15
Stand: 60
Crawl: 0
Walk: 10
Kneel: 0
Lift: 5
Drive: 0
Squat: 2
Climb: 1
Bend: 15
Reach above shoulders: 2

Repetitive use of hands (Frequency indicated):

Simple grasp up to 10# Normal weight:

Pushing &pulling - 50-200#: Occasionally

Fine Manipulation: Typing in computer, omnicell, using pens to chart, drawing up meds in syringe and administration, starting IV's.

Leg Strength - up to 50#: Occasionally- (repetitive use of foot or feet in operating machine control: utilized in positioning beds during transport; x-ray, surgery or in an emergency situation from floor to floor, locking beds or cardiac chairs.)

Environmental Factors &Special Hazards

Environmental Factors (Time Spent):

Inside hours: 12
Outside hours : 0
Temperature: Normal Range
Lighting: Average
Noise levels: Average
Humidity: Normal Range
Atmosphere: Odors

Special Hazards: Radiation, Chemical, Explosive - Chemical-drugs; Explosive-oxygen; Radiation cesium implants and radioactive iodine therapy.

Protective Clothing Required: Gowns, gloves, goggles, masks, HEPA masks for TB.

Pay Range

USD $31.40 - USD $41.21 /Hr

Responsibilities

Required Education and License/Qualifications
Bachelors degree in Nursing, Healthcare Administration, or a related field required.
3+ years of experience in clinical appeals, utilization management, or revenue cycle operations within a healthcare setting.
Strong knowledge of payer policies, medical necessity criteria, and healthcare reimbursement processes.
Excellent analytical, organizational, and problem-solving skills.
Strong written and verbal communication skills, with the ability to craft persuasive appeal letters.
Proficiency in using appeals management software and electronic health records systems (Epic preferred).
Ability to work independently, prioritize tasks effectively, and maintain attention to detail in a fast-paced environment.
Certification Requirement
RN or clinical certification preferred.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes:

Benefits - .5 to 1.0 FTE

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Benefits - .001 to .49 FTE:

Paid Leave Hours accrued as you work
Employee Health Requirements
Exposure/Sensory Requirements
Exposure to: Chemicals: Refer to MSDS manual
Video Display Terminals: Average
Blood and Body Fluids: Diagnostic composite of patients, frequent contact with intravenous devices, and high potential for contact with contaminated body fluids (blood, vomitus, stool) and administration of blood does create a high risk. Use of needleless IV system, universal precautions and protective equipment minimize risk..
TB or Airborne Pathogens: Patient diagnostic presentations do pose high risk. Usage of protective wear and universal precautions minimize risk.
Sensory requirements (speech, vision, smell, hearing, touch): Speech: Required to communicate with patient/families/staff/doctors, coworkers, ancillary personnel and other department heads. Ability to ask for help.
Vision: Required to perform necessary assessments of patient status, medication administration, CIS usage, and reading active orders and lab reports.
Smell: Helpful to note presence of incontinence, vomitus, blood; electrical/fire safety.
Hearing: Necessary to hear alarms, calls for help and to hear patient verbalizations. Necessary to hear lung, bowel and heart sounds. Needed to hear alarms (i.e., fire, codes via PA system).
Touch: Necessary to perform percussive assessments and to comfort patients. Also needed to manipulate tools and equipment.
Activity/Lifting Requirements
Percentage of time during the normal workday the employee is required to: Sit: 10%
Twist: 4%
Stand: 40%
Crawl: 0%
Walk: 25%
Kneel: 1%
Lift: 10%
Drive: 0%
Squat: 1%
Climb: 1%
Bend: 30%
Reach above shoulders: 3%
The weight required to be lifted each normal workday according to the continuum described below:
Up to 10 lbs: Frequently
Up to 20 lbs: Frequently
Up to 35 lbs: Frequently
Up to 60 lbs: Occasionally
Up to 75 lbs: Not Required
Up to 100 lbs: Not Required
Over 100 lbs: Not Required
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting patients off their beds that are unable to move independently is done with assistive lifting equipment. Horizontal movement of patients to and from carts/beds who are unable to move independently is done with assistive lifting equipment. Lifting equipment - carry 25'- 150' waist high (IV bags, patient trays, charts). Filled laundry bags are filled half full so as not to weigh over 35#. Carry fire extinguishers up/down 3-4 flights of stairs and several yards in emergency.
Maximum consecutive time (minutes) during the normal workday for each activity: Sit: 30
Twist: 15
Stand: 60
Crawl: 0
Walk: 10
Kneel: 0
Lift: 5
Drive: 0
Squat: 2
Climb: 1
Bend: 15
Reach above shoulders: 2

CLINICAL APPEALS ANALYST (ON-SITE)

Employer job description

Responsibilities

Our Commitment to You:

Compensation

Benefits - .5 to 1.0 FTE

Benefits - .001 to .49 FTE:

Repetitive use of hands (Frequency indicated):

Simple grasp up to 10# Normal weight:

Environmental Factors (Time Spent):

Responsibilities

Our Commitment to You:

Compensation

Benefits - .5 to 1.0 FTE

Benefits - .001 to .49 FTE:

Repetitive use of hands (Frequency indicated):

Simple grasp up to 10# Normal weight:

Environmental Factors (Time Spent):

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