Clinical Appeals Analyst

Job Summary

A company is looking for a Clinical Appeals Analyst.

Responsibilities:

• Exercise clinical knowledge to make determinations about medical needs or alternatives
• Assess, process, and complete non-routine appeals and grievance to ensure customer satisfaction
• Identify and collect necessary documentation from external sources to determine medical necessity and appropriateness of care

Qualifications:

• Must be an RN, LPN, Physical Therapist, or Occupational Therapist
• Must be licensed in the state of NC or have compact licensure
• 3+ years of managed care experience
• Claims and appeals experience, preferred