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Christian Care Ministry · 1 month ago

Appeals Nurse (LPN)

Melbourne, FL | Orlando, FL | Hybrid

Full-time

Hybrid

Mid Level

$25/hr - $34.13/hr

Christian Care Ministry is a healthcare sharing ministry for Christians that connects people to a Christ-centered community wellness experience. The Appeals Nurse (LPN) is responsible for supporting the Appeals/Grievances function by guiding members through the appeals process and gathering necessary medical information.

Financial ServicesHealth CareNon Profit

Responsibilities

Answer member questions about medical records, how they apply to their bills, and the appeal process

Communicate with members and/or providers what is needed for case review preparation and delivery of determination status

Organize and ensure we have all needed medical records, lab results, and radiological reports, etc

Learn and maintain an understanding of Medi-share program guidelines and appeals processing functions

Acquire medical records for appeals from providers

Keep members informed of the appeal process and pray with them

Coordinate the next steps in the appeal process when necessary

Set up the next level of appeals for members

Be a point of contact for member while in appeals process

Maintain workflow follow up in various queues

Document medical correspondence received from members and providers following approved processes

Receive inbound and place outbound calls from/to members and providers

Help to maximize cost savings by referring cases to other departments, as needed

Assist with overflow from Appeals Admin; such as obtaining medical records, help with conclusion letters, contacting members or help any way with overflow and coverage

Work autonomously to prioritize and manage workload

Comply with all organizational HIPAA requirements

Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs

All other duties as assigned

Qualification

LPN licenseMedical record reviewsAnatomy knowledgeMicrosoft OfficeMultitaskingDatabase system usageInterpersonal skillsCommunication skills

Required

LPN license required with sound knowledge of anatomy and physiology and disease processes required

Ability to multitask in multiple operating systems

Ability to work for extended periods of time on the computer

Ability to be objective and impartial

Ability to de-escalate difficult conversations

Ability to communicate effectively with both internal and external customers

Possess ability to adapt to changing processes

Working knowledge and application of program guidelines

Ability to practice good interpersonal skills and work as a member of a team

Ability to work autonomously to prioritize and manage workload

Knowledge in the use of the internet including e-mail and search engines

Word processing and keyboard skills of at least 25 wpm

Basic knowledge in Microsoft Office (Excel, Word, Outlook)

Ability to use a database system, including how to update fields

Knowledge of a document imaging system

Drives Results – consistently achieves review results, even under tough circumstances and tight deadlines

Courage – ability to supply objective conclusions based on review regardless of risk or potential criticism

Initiative – identifying what needs to be done with a willingness to take action

Member First – exhibits full commitment to serving members and/or clients by prioritizing their needs first in alignment with our program's purpose

Humble – demonstrates Christ-Centered humility by honoring others, accepting feedback, and prioritizing collective success over individual recognition

Hungry – exhibits initiative, perseverance, and commitment to serving God through excellence

Smart – shows relational and emotional intelligence, communicates effectively, collaborates harmoniously, and reads social cues with grace and discernment

Preferred

Experience in medical record clinical reviews or appeal/grievances within a healthcare payer organization preferred

Benefits

100% paid Medical for employees/99% for family

Generous employer Health Savings Account (HSA) contributions

Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance

6 weeks of paid parental leave (for both mom and dad)

Dental - two plans to choose from

Vision

Short-term Disability

Accident, Critical Illness, Hospital Indemnity

401(k) – up to 4% match on ROTH or Traditional contributions

Generous paid-time off and 11 paid holidays

Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo

Employee Assistance Program including no cost, in-person mental health visits and employee discounts

Monetary Anniversary Awards Program

Monetary Birthday Awards

Company

Christian Care Ministry

Christian Care Ministry (CCM) is a non-profit that administers Medi-Share, a healthcare sharing program where Christians come together to share each other’s medical bills.

Founded in 1993