Arizona RN Med Appeals Coordinator

Job Summary

Working remotely on a contract basis, the Arizona RN Med Appeals Coordinator will perform in-depth analysis and resolution of provider appeals, member grievances, and inquiries while maintaining compliance with regulatory standards.

Key responsibilities

• Conduct clinical reviews and manage the resolution of provider appeals and member grievances across all lines of business
• Analyze medical records and benefit plan requirements to determine the appropriateness of appeal and grievance requests
• Maintain accurate records and meet performance goals in accordance with department guidelines and regulatory requirements

Required qualifications

• Active, current, and unrestricted RN license in Arizona or a compact state
• Associate's Degree in a healthcare field or Nursing Diploma
• Minimum of 1 year of experience in clinical and health insurance or a related healthcare field
• Intermediate proficiency in PC and office equipment
• Advanced clinical knowledge and the ability to interpret policies and procedures