Florida Licensed Medicare Appeals RN
Job Summary
A company is looking for a Medicare Appeals RN.
Key Responsibilities
- Reviews and researches appeals to ensure timely and appropriate determinations
- Processes post service reviews and collaborates with Medical Directors for final determinations
- Prepares and presents clinical appeal cases while adhering to regulatory requirements
Required Qualifications
- 2+ years of clinical experience in a related field
- Bachelor's degree in a related field or equivalent work experience
- Current State of Florida Licensed Registered Nurse (RN) or Compact State Licensure
- Proven experience with Medical Coverage Guidelines, including medical necessity
- Familiarity with HIPAA and ERISA requirements
COMPLETE JOB DESCRIPTION
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