NC MMIS - Prior Approval Nurse Analyst
Location: Raleigh North Carolina
Description: AppLabs is presently looking of NC MMIS - Prior Approval Nurse Analyst right now, this career will be placed in North Carolina. For complete informations about this career opportunity please give attention to these descriptions. Essential Job Functions
Performing under North Carolina state approved criteria that outlines policies and requirements, this position dete! rmines prior approval for specified procedures.
Analyzes insurance and matured endowment claims to ensure compliance with organizational and government guidelines.
Maintains an ongoing effort to determine and maintain equity with current claims trends.
Conducts analysis of current claims trends and investigates means to improve claim processes. Recommends improvements and implements same as approved.
Researches and investigates claims systems to evaluate potential impact to organization. Recommends adjustments or changes to systems as appropriate.
Analyzes claims financial reporting practices and reconciliation for client companies. Identifies issues and recommends alternative courses of action.
Informs management of potential liabilities or process improvements related to current claims practices.
Provides leadership and work guidance to less experienced personnel.
Qualifications
Basic Qualifi! cations
Bachelor's degree or equivalent combination o! f education and experience
Bachelor's degree in insurance, business administration or related field preferred
Two or more years of claims experience
Experience working with Lotus Notes, Vantage, DRPS, Life 70, Keymaster and CK4
Experience with investigating internal claims practices
Experience working with appropriate claims processing procedures and documentation, and administrative procedures, legislative requirements, and medical principles as they related to examination and approval of life and disability insurance claims
Other Qualifications
Performs review of prior approval requests for medical services; may assist in preparation of mediations and hearings
Requires active RN or LPN issues by the State of North Carolina
Preference for knowledge of MMIS Fiscal Agent Operations
Preference for knowledge of business processes of the NC DHHS and/or Health Choice.
Strong analyt! ical and problem solving skills
Strong interpersonal skills to interact with team members
Strong communication skills to communicate with clients
Good human relations skills to provide leadership and work guidance to less experienced personnel
Ability to keep sensitive and confidential material private
Ability to work in a team environment
CSC is an Equal Opportunity Employer M/F/D/V
- .
If you were eligible to this career, please email us your resume, with salary requirements and a resume to AppLabs.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Wed, 10 Jul 2013 21:40:23 GMT