Clinical Appeals Registered Nurse

Job Summary

A company is looking for a Clinical Denials and Appeals RN.

Key Responsibilities

• Secure pre-service approvals and review pre/post service denials
• Conduct comprehensive denial root-cause analysis and retrospective medical record reviews
• Coordinate pre-service authorization approvals and construct warranted appeals

Required Qualifications

• Bachelor's Degree (relevant experience may substitute formal education)
• Current Registered Nursing License
• Minimum of 4-6 years of prior clinical experience
• Familiarity with medical records assembly and clinical terminology
• Working knowledge of basic coding guidelines