Appeals Reviewer Veteran Job Description Samples

Results for the star of Appeals Reviewer Veteran

Appeals Reviewer RN

Appeals Reviewer RN Department: Case Management Resource Center Schedule: Per diem Shift: AM shift Hours: Job Details: Glendale Adventist Medical Center (GAMC) is a 515-bed hospital built on the Seventh-day Adventist faith and mission to improve the health of communities and to share God's love by promoting healing and wellness for the whole person. Job Summary The Appeals Reviewer RN is responsible for recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review, and the preparation of documentation of appeals based on disputed/denied clinical criteria. The preparation of this information will be based on accepted industry criteria. Job Duties + Performs retrospective, post discharge, and post serviced medical necessity review to determine appellate potential of clinical disputes/denial or those eligible for clinical review.

  • Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate medical necessity criteria. If clinical review does not meet InterQual criteria, other pertinent clinical facts are utilized to support the appeal.

  • Demonstrates ability to critically think, problem solve, and make independent decision supporting the clinical appeal process.

  • Demonstrates proficiency in utilization of electronic tools, including but not limited to Cerner Power Chart, Cerner Care Management, and RCI revenue applications.

  • Must have strong clinical assessment and critical thinking skills necessary to identify potential quality issues, delays in service, post-acute care needs required Requirements

  • Must possess a current, valid CA nursing license

  • Minimum of 5 years recent acute experience.

  • Medical-surgical /Critical care experience preferred, but not required.

  • Minimum of 2 years UR/Case Management experience.

  • Managed care payer experience a plus either in Utilization, Case Management or Appeals. HR Use Only:

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RAC Audit Appeals Reviewer / Ascension Wisconsin Corp / Recovery Audit Complaince / FT Days / 80 Hou


Job ID:
192751

RAC Audit Appeals Reviewer / Ascension Wisconsin Corp / Recovery Audit Complaince / FT Days / 80 Hours Biweekly

Appleton, Wisconsin

Regular / Day

Additional Job Information

Title:?RAC Audit Appeals Reviewer

City,
State:
?
Appleton,WI


Location:
?
AHS
Appleton Bus Serv 222Department:
?? Recovery
Audit Compliance 001Additi
onal Job Details:??Full-Time, Day,?80 hours, Biweekly

Marketing Statement

Ascension Wisconsin serves millions of people across the state with 24 hospitals and hundreds of sites of care. Approximately 23,500 associates, including nearly 1,000 medical group clinicians work collaboratively to deliver compassionate, personalized care every day. Ascension Wisconsin includes hospitals, clinics and doctors? offices from Affinity Health System, Columbia St. Mary?s, Ministry Health Care, and Wheaton Franciscan Healthcare. As part of Ascension, the largest non-profit health system in the U.S. and the world?s largest Catholic health system, in fiscal year 2015, Ascension Wisconsin provided $300 million in community benefit including care of persons living in poverty. We provide compassionate, personalized care for all, including those who are struggling. And we?re improving collaboration across healthcare in Wisconsin.? We?re looking for talented associates to join us as we continue advancing healthcare across Wisconsin.

Job Description

Job Summary:

Coordinates payer denials and appeals, responds to insurance company requests for medical records, and performs medical record reviews.

?


Responsibilities:

  • Reviews medical records to determine accuracy of billing through verification of coding, billing and supporting clinical documentation.
  • Coordinates all activities associated with insurance carrier audit requests and works with payers to ensure timely handling of these payer audits.
  • Reviews technical payer denials and determines whether an appeal is justified. Writes and tracks technical appeal letters and relay information with billing department.
  • Conducts audits to ensure accurate charge capture, enhance reimbursement and identify savings potential.


Qualifications

Licenses/Certifications/Registration:

  • Required Credential(s):
    • Licensed?Registered Nurse?credentialed from the?state of Wisconsin?or current home state license for multi-state license recognition "Compact State"?obtained prior to hire date or job transfer date.?

Education:

  • Diploma?
    • Graduate of an accredited school of Nursing required
    • Bachelor's Degree preferred

Work Experience:

  • Minimum three (3) years of related experience required.

How To Apply

We urge you to apply to any/all positions that you have interest in, and should you fit the qualifications for the role we will certainly reach out to you. Please ensure you complete all required fields within the application (indicated with an asterisk), as well additional information that is requested of you. Information that you offer us will better assist us in understating your qualification and fit for the position(s) you?ve applied.
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For questions or assistance with completing the online application, please contact Ascension candidate care at 855-778-6037.
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Also to note, our online application system may not be compatible with non-Windows based operating systems (iPhones, iPads, or Mac Computers) or non-internet Explorer browsers.
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Please note that Ascension, and its affiliates and subsidiaries, will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.?

Equal Employment Opportunity

Ministry Health Care, and its subsidiaries, as part of Ascension Health, is an equal opportunity employer and will not discriminate against employees or prospective employees on basis of age, race, creed, color, religion, marital status, sex, national origin, ancestry, citizenship, sexual orientation, disability, arrest and/or conviction record, military status, protected veteran status, or any other characteristic or status protected by law.
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For further information regarding your EEO rights, click on the following link to the ?EEO is the Law? poster:
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M/F/Disabled/Vet
?
?
EEO is the Law Poster Supplement
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Clinical Appeals Reviewer - Denials Team - Multiple Locations


Job Description
Position Description:
Energize your career with one of Healthcare---s fastest growing companies.
You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it---s a dream that definitely can come true. Already one of the world---s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our Service Centers, improve our Service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 14 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions, and treatments; helping them to navigate the system, finance their Healthcare needs, and stay on track with their Health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation, and Performance.
Employees in this position are responsible for assembling and delivering written notification for Care Advocacy and Peer Reviewer issued denials within required timeframe for all levels of care for all delegated accounts. The denials may include Pre-Service and Concurrent UM and administrative requests, Post-Service cases (retrospective reviews, Clinical Claims Review) and Reconsiderations.
Primary
Responsibilities:

  • Retrieve work received from Care Advocacy via system work list
  • Document request in A&G denial note
  • Ensure accurate data entry
  • Prioritize work based on due date and run applicable work list reports to monitor workload
  • Plans, prioritize, organize and complete work to meet established and required time frames
  • Ensure correct letter template is utilized
  • Complete template with appropriate information and rationale
  • Select correct attachment and / or enclosure(s) and add to template
  • Send out completed written notification as indicated under applicable department policies
  • Process mail / correspondence received for retrospective reviews
  • Participates in workgroups and committees as requested
  • Solves moderately complex problems independently
  • Works with team to solve complex problems
  • Supervision / guidance is required for higher level tasks
  • Other duties as assigned
    Required Qualifications:
    • High School Diploma or GED
    • 1+ years of healthcare insurance experience
    • 6+ months of data entry experience
    • Experience using a computer and Microsoft Office (Word, Excel, and Outlook)
    • Must live in St. Louis, MO, Shaumberg, IL, or Philadelphia, PA
      Preferred Qualifications:
      • Any college experience
      • Familiarity with medical terminology
      • Experience with medical claims
      • Telephonic customer service experience
      • Experience with ISEET, IQ and / or UM
        Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.
        Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
        UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Appeals Reviewer RN - Case Management Resource Center

Glendale Adventist Medical Center (GAMC) is a 515-bed hospital built on the Seventh-day Adventist faith and mission to improve the health of communities and to share God's love by promoting healing and wellness for the whole person.

Job Summary

The Appeals Reviewer RN is responsible for recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review, and the preparation of documentation of appeals based on disputed/denied clinical criteria. The preparation of this information will be based on accepted industry criteria.

Job Duties

  • Performs retrospective, post discharge, and post serviced medical necessity review to determine appellate potential of clinical disputes/denial or those eligible for clinical review.

  • Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate medical necessity criteria. If clinical review does not meet InterQual criteria, other pertinent clinical facts are utilized to support the appeal.

  • Demonstrates ability to critically think, problem solve, and make independent decision supporting the clinical appeal process.

  • Demonstrates proficiency in utilization of electronic tools, including but not limited to Cerner Power Chart, Cerner Care Management, and RCI revenue applications.

  • Must have strong clinical assessment and critical thinking skills necessary to identify potential quality issues, delays in service, post-acute care needs required

Requirements

  • Must possess a current, valid CA nursing license

  • Minimum of 5 years recent acute experience.

  • Medical-surgical /Critical care experience preferred, but not required.

  • Minimum of 2 years UR/Case Management experience.

  • Managed care payer experience a plus either in Utilization, Case Management or Appeals.

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Appeals Registered Nurse Reviewer

Job Summary

The RN Appeals Reviewer maintains database of disputed/denied clinical claims and tracking for timely submission of those eligible for appeal either by clinical review, administrative action and settlement. The appeals RN will be responsible for preparation of case review and documentation of appeals based on disputed/denied clinical criteria. The preparation of this information will be based on accepted industry criteria.

Job Duties

  • Performs retrospective, post discharge, and post serviced medical necessity review to determine appeal potential of clinical disputes/denial or those eligible for clinical review.
  • Critical thinking and demonstrates ability to make independent decision supporting the clinical appeal process.
  • Constructs and documents a clear fact based clinical case to support appeal utilizing appropriate medical necessity criteria. If clinical review does not meet InterQual criteria, other pertinent clinical facts are utilized to support the appeal.
  • Must have strong clinical assessment and critical thinking skills necessary to identify potential quality issues, delays in service, post-acute care needs required
  • Demonstrates proficiency in utilization of electronic tools, including but not limited to Medetech, Epic,or Care Advance applications.

Requirements

  • Unrestricted valid CA Registered Nurse license
  • Minimum of 2 years UR/Case Management experience.
  • Managed care payer experience a plus either in Utilization, Case Management or Appeals.
  • Minimum of 5 years recent acute experience.
  • Medical-surgical /Critical care experience preferred, but not required.
Job Posted by ApplicantPro

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Utilization Review & Appeals RN

For more than 100 years, Southern New Hampshire Medical Center has honored our mission: to improve, maintain, and preserve the overall health and well-being of individuals living in the greater Nashua area by providing information, education, and access to exceptional health and medical care services.

We have literally been at the heart of better health for Greater Nashua. Our main downtown campus, a familiar landmark for generations, has grown along with the Gate City. Today, The Medical Center and our affiliated doctors and services extend across much of southern New Hampshire.

Summary:

The Utilization Review & Appeals RN evaluates medical acuity to assess for appropriate level of care orders and documentation to facilitate insurance coverage. Works directly with care team to proactively prevent denials and ensure level of care charges are applied accurately per commercial and CMS insurance guidelines. Appeals medical necessity insurance denials. Conducts charge reviews to ensure insurance rules are followed.

Qualifications:

  • Bachelor's degree in nursing

  • Three to five years experience in acute care Utilization Review and Appeal writing

  • Experience in use of Interqual, Milliman and other Healthcare acute criteria

  • Excellent writen and verbal communication skills

  • Competent in Microsoft Office and general computer skills

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Phoenix Appeals & Grievances RN - Managed Care

Appeals & Grievances Nurse (RN) – Managed Care
Phoenix, AZ
Your
Job Summary:

The Quality Improvement Appeals & Grievances Nurse performs all aspects of the Quality Management Program, including the grievances and appeals process, performance improvement, accreditation and regulatory requirements, and all related activities, objectives, and analysis. The nurse supports the organization by working to resolve provider payment disputes through advanced and complicated case review of the appropriateness of medical care requiring considerable clinical judgment, independent analysis, and detailed knowledge of managed care and organizational guidelines.    The nurse is responsible for oversight and execution of the grievance and appeals process, which includes coordinating the investigation among departments, analysis of root causes, collaborating with staff to develop corrective action plans, and monitoring corrective action taken. Manages the consolidation of the complaints and grievance activities on a quarterly basis, and prepares monthly, quarterly and annual reports on assigned quality improvement activities.
Your Reward: 
EXCELLENT BENEFITS AND HIGHLY COMPETITIVE SALARY OFFERED!
This growing organization is committed to the health and happiness of all their staff. They offer a comprehensive benefits package to all full-time, permanent employees including zero cost health insurance plan, dental, vision, and life insurance, wellness programs, tuition assistance, matching 401(k) with instant vesting, on site gym and cafeteria, company-wide annual bonus (10%-13% of salary), generous PTO plus paid holidays, and much more!
Your Background:
Current, valid, and unrestricted state Registered Nurse (R.N.) license.
Roughly 2-5 years acute care clinical nursing experience is required.
At least 1 year previous experience in Denials & Grievances & Appeals, Utilization Review in a Managed Care Organization.
Around 2-4 years of recent experience at a health plan or other Managed Care Organization (HMO/TPA/IPA/etc).
Requires 1-3 years of customer service experience communicating directly with members to identify their true complaint and obtain any additional information to resolve their case.
Understand Utilization Review guidelines, Medicare and Medicaid regulations, and appropriate state plan requirements.
Experience using standardized clinical guidelines, preferably InterQual, is required.  Must be able to differentiate between PCP rendered care and specialty care; and be able to identify clinical quality of care issues.
Possess excellent communication and interpersonal skills; in person, over the phone, and in writing.
Able to work independently and multitask, handling multiple projects and prioritizing workflows.
Your Duties:
Facilitates continuous improvement in the health plan delegated networks by providing individualized case review and processing.  Performs clinical review related to Grievances, Appeals, Quality Referrals and Occurrences by identifying the issues of the case, ordering and collecting needed documents or records, reviewing the case documents, completing a case summary, and either leveling or reviewing the case with the Medical Director or CMO as appropriate.  Coordinates and submits results of focused review studies, medical record audits and HEDIS results as appropriate. 
Acts in the capacity of member advocate addressing member or provider concerns, maintaining absolute file integrity with regards to content, location, and confidentiality.  Conducts clinical review and evaluation of member and provider complaints, grievances and appeals using considerable clinical judgment, evidence based standards, independent analysis, knowledge of operational policies, clinical guidelines, plan benefit structures and regulatory requirements to determine the appropriateness of care provided.  Reviews, triages and prioritizes cases to meet required turnaround times.  Ensures that appeals and grievances are categorized and processed within appropriate state and federal time frames. Interacts with external partners, including providers, medical groups, IPAs and other external vendors to obtain additional information to resolve the member's case.   Interaction includes preparing for and participating in regulatory site visits.  Performs research and analyzes complex issues.  Identifies potential quality issues and initiates investigations, processing any substantiated quality of care issues.  Summarizes cases including articulation of member's perception, initial denial determination and notification, analysis of medical records, and appropriate application of all applicable policies, guidelines, benefit plans and laws, rules and regulations. 
Maintains strict compliance with federal, state and NCQA requirements and guidelines.  Participates in and coordinates Quality Management committee activities by assisting with development of the agenda, providing the assigned meeting documents, and presenting reports.  Provides complete and accurate documentation of work performed by entering data into specified databases or forms as instructed and reporting any required metrics.  Participates in the Quality Management process by identifying problems, examining solutions options, implementing action plans and by coordinating, facilitating and/or participating in inter and intradepartmental quality initiatives and work groups.

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Registered Nurse - Appeals

We’re working on behalf of a NYSE-listed company in Tampa that focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage, and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs.  The company serves approximately 3.8 million members nationwide through its quality and cost-effective health care solutions, and is committed to continually improving the quality of care and service its provide to its members, helping them access the right care at the right time in the appropriate setting.
We seek candidates with inpatient experience within an acute care clinical setting (Med Surge, Telemetry, ER or ICU) for the role of Appeals Reviewer.  In this role you will be responsible for preparing cases for physician review and all appeal related activities accurately, efficiently, and within mandated timeline requirements.  You will perform appeal reviews on medical and/or behavioral health records and cases utilizing established guidelines and member benefit plans.  You will communicate the outcome of the appeals process with members, internal and external partners.  You will utilize company designated criteria along with clinical knowledge to make authorization decisions and assist the Medical Director with appeal determinations.  You will collect information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation necessary to reach prospective, concurrent and retrospective decisions in the appeals process.  
Candidates must be a graduate of an accredited school of nursing and be licensed as an RN or LPN in the state of Florida.  Must have two (2) or more years of experience in an acute care clinical setting with general nursing exposure in UM to include pre-auth.   Must have two (2) or more years in Managed Care experience.  Must have working knowledge of InterQual criteria.
Competitive compensation and benefits.   This is an excellent opportunity to join an organization employs more than 7000 employees across the country, and fosters a rewarding and enriching culture that inspires its associates to do well for others and themselves.  For more information call 941.739.1400 or submit your resume now by clicking on the button below that says “Apply Now.”

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Attorney Advisor (Board Of Veterans Appeals)

Board of Veterans Appeals


Many vacancies in the following location:

  • Washington DC, DC ##### Work Schedule is Full Time
  • Permanent Opened Friday 9/16/2016 (196 day(s) ago)Closes Friday 3/31/2017 (0 day(s) away) ## Job Overview

Summary Vacancy Identification Number


(VIN) #1801715

OUR MISSION: To fulfill President Lincoln's promise – "To care for him who shall have borne the battle, and for his widow, and his orphan" – by serving and honoring the men and women who are America's Veterans. How would you like to become a part of a team providing compassionate care to Veterans?

The Department of Veterans Affairs (VA) needs employees who possess the energy, compassion, and commitment to serve those who served our Country. Whatever the job title, every position in VA will give you a chance to make a meaningful and personal contribution to the lives of truly special and deserving people - our Veterans. VA professionals feel good about their careers and their ability to balance work and home life.

VA offers generous paid time off and a variety of predictable and flexible scheduling opportunities. Working for VA is one of the most emotionally satisfying and professionally rewarding ways to dedicate the best within you to your Country's service. If you are transitioning from the military or a Veteran already, we invite you to explore the benefits of continuing your career at the VA.

The VA is committed to hiring Veterans. The VA is much more than just another employer.

It is an honorable, open and welcoming community of those who care. Gratitude is our motivation and service is our mission. The VA has adopted Core Values and Characteristics that apply universally across the Department.

The five Core Values define "who we are," our culture, and how we care for Veterans, their families and other beneficiaries. The Values are

Integrity,

Commitment,

Advocacy,

Respect and

Excellence ("

I CARE"). As a VA professional, your opportunities are endless. With many openings in the multiple functions of VA, you will have a wide range of opportunities and leadership positions at your fingertips. For more information on the Department of Veterans Affairs, go to http://www.vacareers.va.gov/. ### Duties An

Attorney Advisor for the Board of Veterans' Appeals (BVA or Board), must be able to handle all types of appeals, including those of exceptional difficulty, complexity or controversy. This position requires expert knowledge of the laws and regulations pertaining to Veterans' benefits, as set forth primarily in title 38 of the United States Code and the Code of Federal Regulations; the precedent decisions of the United States Court of Appeals for Veterans Claims (CAVC), the United States Court of Appeals for the Federal Circuit (Federal Circuit), and the United States Supreme Court; and the precedent decisions of the Department of Veterans Affairs (VA) General Counsel.

The jurisdiction of BVA extends to all questions of law and fact under laws that affect the provision of benefits by the Secretary to Veterans or their dependents or survivors. As a new Attorney with BVA you will receive formal training in the professional appellate work performed in the Board of Veterans Appeals to perform the following:

MAJOR DUTIES: * Review and evaluate medical and lay evidence.

  • Draft tentative appellate decisions for review and signature by a Veterans Law Judge.

  • Apply the laws administered by VA to the facts in the individual cases.

  • Conduct research on legal and medical questions encountered in case review.

  • Draft legal briefs outlining the facts at issue and provide recommendations for appropriate action.

Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level


Travel Required

  • Not Required

Relocation Authorized

  • No

Job Requirements


Key Requirements

  • You must be a U.S. citizen to apply for this job.

  • Subject to a background/suitability investigation.

  • Designated and/or random drug testing may be required.

  • May be required to serve a probationary period.

  • Selective Service Registration is required for males born after 12/31/1959. * A complete application package: Resume, Transcripts, Bar Membership, etc.

Qualifications To qualify for this position


, applicants must meet all requirements by the closing date of this announcement. BASIC REQUIREMENTS-BAR MEMBERSHIP REQUIREMENTS: Be a member in good standing of the bar of a State or Territory of the United States, or the District of Columbia. Where the duties of the position call for appearance in court, the applicant must be a member in good standing of the bar, or be eligible for admission to the bar, of the State or Territory of the United States or the District of Columbia which they will serve. EDUCATION: Possess a Bachelor of Laws or Juris Doctor degree from a law school or be awarded such before appointment.

NOTE: The education requirements are not applicable to those employees serving in Attorney positions in the VA as of September 1, 1968. It is the applicant's responsibility to provide documentation or proof that he or she has met the applicable educational requirements for substitution. Applications submitted without the required supporting documents will not be accepted.

An unofficial transcript; statement from the institution's registrar, dean, or other appropriate official; or equivalent documentation is acceptable at the time of application. Education submitted must be appropriately accredited by an accrediting body recognized by the Secretary of the U.S. Department of Education.

For additional information, refer to the U.S. Department of Education web site at http://www.ed.gov/.

MINIMUM QUALIFICATIONS:

GS-11: One year of experience as described below, or Possession of the LL.M. / JD degree, or Graduation in the upper one-third of his/her law class or one of the six alternate options of the Superior Law Student Program: 1. Work or achievement of significance on his/her school's Official Law Review; 2.

Special high-level honors for academic excellence in law school, such as election to the Order of the Coif; 3. Winning a moot court competition or membership on the moot court team which represents the law school in competition with other law schools; 4. Full-time or continuous participation in a legal aid program as opposed to one-shot, intermittent or casual participation; 5.

Significant summer law-office clerk experience; or 6. Other equivalent evidence of superior achievement. Candidates applying under this option will be required to furnish certification from the registrar of ranking and other attainments in law school. EXPERIENCE: In one or any combination of the following types in the amounts indicated for each grade following: * Practice of law.

  • Other legal experience of a responsible nature in any or a combination of the following: As a law clerk; in legal research; in analysis of statutes; or in examination, investigation, or adjustment of claims arising under law, contract, or governmental order.

  • In the military, naval, or other Federal service in the disposition of legal problems, as a reviewing officer, as a member of courts or boards, or investigation activities. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. No prior Federal experience is required.

Physical Requirements: The work is physically demanding and consists of the incumbent transporting rolling carts weighing up to 100 pounds, routine bending and lifting of claims folders, boxes, or other items weighing approximately 20 pounds. Filing and retrieving folders, boxes, and other items that can weigh approximately 20 pounds on shelves that require the use of a step stool. Occasionally, it will be necessary to lift and carry larger and heavier files. Time-in-grade: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements.


Security Clearance Public Trust

  • Background Investigation

Additional Information


What To Expect Next After the vacancy announcement closes


, applicants are evaluated to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email.


BENEFITS VA offers a comprehensive benefits package


. This link provides is an overview of the benefits currently offered: http://www.vacareers.va.gov/why-choose-va/benefits/index.asp . VA supports the use of telework as a way to help attract and retain talented individuals in public service, increase worker productivity, and better prepare the agency to operate during emergencies. This position may be authorized for telework.

Please note that Telework and Alternative Work Schedules (AWS) are not available during the first year of employment to afford selectees extensive in-house training and mentoring. Telework eligibility will be discussed during the interview process.


Other Information


This is an open continuous announcement. The initial cut off date for referral is September 30, 2016. After this date additional referral lists will be created on the last day of each month. This announcement covers multiple positions within the Board of Veterans Appeals through March 31, 2017. If necessary, additional cut-off dates will be established throughout the open period of the announcement depending on the hiring needs of the agency.

Bargaining Unit: This position is covered under the bargaining unit. This position is in the Excepted Service and does not confer competitive status. Veterans Preference does not apply to Excepted Service Attorney appointments in the Federal service; however the Department of Veterans Affairs considers veteran's preference eligibility as a positive factor in the hiring process. Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. VA may offer newly-appointed Federal employee's credit for their job-related non-federal experience or active duty uniformed military service.

This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed.

Placement Policy: The posting of this announcement does not obligate management to fill a vacancy or vacancies by promotion. The position may be filled by reassignment, change to lower grade, transfer, appointment, or reinstatement.

Management may use any one or any combination of these methods to fill the position. This job opportunity announcement may be used to fill additional vacancies.

Salary Range: $64,650.00 to $84,044.00 / Per Year Series & Grade: GS-0905-11/11 Promotion Potential: 14 Supervisory Status: No Who May Apply: United States Citizens Control Number: 450515300 Job Announcement Number: COE-16-1801715-TT



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Clinical Resource Management, Appeals Coordinator

Clinical Resource Management, Appeals Coordinator Send This Job to a Friend Department Clinical Resource Management Schedule Full Time Benefits Eligible (Nursing) - NF Shift Day Shift (1) Hours 80 Job Details GENERAL SUMMARY Responsible for coordinating and monitoring the denial management and appeals process. Combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided.

Collaborates with physicians, case managers, revenue cycle personnel and payers to appeal denials. EDUCATION: Bachelor's Degree from an accredited school of nursing is required. PRIOR EXPERIENCE:

Minimum of three to five years as clinical nurse in an acute care setting. Extensive knowledge of clinical symptomotology and related treatment and hospital utilization management. Knowledge of current reimbursement models: commercial, managed care, Medicare, Public Assistance.

Technical writing ability for appeal letters and reports. CERTIFICATION/REGISTRATION/LICENSURE: Current RN license.



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