Who we are:
Meridian Health Plan is a family-owned, family-operated company of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in five different states (Michigan, Illinois, Indiana, Kentucky, and Ohio).
Our employees work hard, play hard, and give back. Meridian employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, weekly Executive Lunches, and volunteer opportunities.
A Day in the Life of a Denials Nurse:
This position is responsible for review and response of the adverse decisions for members of the health plan. Successfully maintains Federal and Local guidelines to meet general accreditation status with regard to denial letters. Responsible for the writing and editing of all letters sent out for denials.Responsibilities
- Responsible for reviewing all aspects of the denial processes within the department to promote consistency and accuracy within the processes and compliance with Medicare, NCQA, URAC or general accreditation, regulatory and HIPAA guidelines
- Meets all relevant regulatory requirements and comprehends and complies with best practices, professional standards, internal policies and procedures
- Analyzes the daily denial activities to ensure departmental goals are met with regards to timeliness, accuracy and consistency of medical decisions
- Recognizes opportunities to improve the quality of care/services and activities to continually strive to improve outcomes
- Responsible for providing expertise or general support to Denials Specialist staff in reviewing, researching, investigating, negotiating and resolving all types of denials
- Communicates with appropriate parties, issues, implications and decisions
- Responsible for assisting in clinical coordination and presentation of information for administrative hearings and state external reviews
- Partnering with the Denials Team Lead to work with the IT department on MCS development issues as it pertains to denials
- Maintain strict confidentiality of employee and organizational information in accordance with MHP, HIPAA and State privacy regulations
What you can bring to Meridian:
- Current licensure to practice as a Registered Nurse or a Licensed Practical Nurse in the designated State, without restriction is required
- Three to five years of experience, education and/or certifications in utilization management, case management or other appropriate health care specialty
What Meridian can offer you:
- Our healthcare benefits include a variety of PPO plans that are effective on the first day of employment for our new full-time team members.
- Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
- Meridian offers 401k matching that is above the national average.
- Full-time MHP employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
- Meridian Health Plan was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.
- Meridian is an Equal Opportunity Employer