Florida Licensed RN Healthcare Appeals Analyst
Job Summary
Working remotely on a full-time basis, the Florida Licensed RN Healthcare Appeals Analyst will review provider appeals to ensure proper processing according to coverage guidelines, make final determinations based on findings, and document results while adhering to regulatory timelines.
Key responsibilities
- Review and research provider appeals and medical documentation to reach final determinations
- Collaborate with the Managing Medical Director to facilitate changes to medical coverage guidelines
- Prepare and present clinical appeal cases to the Provider Appeal Panel, ensuring compliance with regulatory requirements
Required qualifications
- 2+ years of related clinical experience
- Active RN - Registered Nurse - State Licensure in Florida or Compact State Licensure
- Related Bachelor's degree or equivalent work experience
- Extensive experience with Medical Coverage Guidelines related to medical necessity and experimental procedures
- Knowledge of HIPAA and ERISA requirements
Complete Job Description
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