Job Summary

A company is looking for a Clinical Appeals Analyst for a remote position.

Responsibilities:

• Assess, analyze, and complete non-routine appeals and grievances to ensure customer satisfaction
• Document all work through external sources such as pharmaceutical companies, healthcare providers, and attorneys
• Report to the Manager, Nurse Lead/Team Leader, and Medical Lead

Qualifications:

• Must have an RN or LPN license in North Carolina
• Requires 3+ years of inpatient care experience in various units
• Experience with electronic medical record (EMR) systems
• Must adhere to mandated and legislative requirements set by the NCDOI or the NCQA