What is Aspirion?

Aspirion Health Resources is an industry-leading provider of complex claims management services. We specialize in Motor Vehicle Accidents, Worker’s Compensation, Veterans Administration and Tricare, Complex Denials, Out-of-State Medicaid, and Eligibility and Enrollment Services. Our employees work in an environment that is both challenging and rewarding. We ask a lot out of our team members and in return we offer flexibility, autonomy, and endless opportunities for advancement. As we are committed to growth within the complex claims industry, we offer the same growth to our employees.

What do we need?

The Utilization Review/ Appeals Nurse is a key component to our team working closely with denial experts to successfully resolve clinical denials received from the government and/or third-party payers.

Duties

• Analyze medical documentation to formulate a clear and concise clinically based argument to overturn denials.
• Adheres to HIPAA guidelines regarding PHI.
• Exhibits clear and complete communication when documenting in company or client systems.
• Capture clinical data elements in order to provide trending to hospital partners

Requirements

What will you provide?

• LPN or RN, with experience in an acute hospital utilization review and/or case management is required.
• Case Management/Utilization Review certification is a plus
• Previous experience appealing clinical denials for hospitals/physicians is a plus
• Understanding/experience with InterQual, Milliman Care Guidelines, and other criteria used for medical necessity determinations.
• Computer skills required (Microsoft Word, Excel, Outlook)
• Experience in acute care hospital utilization review and/or case management is required.
• Attention to detail with problem solving mentality
• Strong communication (both oral and written), documentation, and critical thinking skills essential
• Strong problem solving and decision-making skills
• Ability to work independently
• Ability to multi-task effectively
• HIPAA compliant

This is a full-time exempt/salaried position.

Benefits

At Aspirion we invest in our employees by offering unlimited opportunities for advancement, a full benefits package, including health, dental, vision and life insurance, matching 401k, competitive salaries and incentive programs.

AAP/EEO Statement

Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to.