Kentucky Licensed Clinical Denial Specialist

Job Summary

A company is looking for a Specialist Clinical Denial.

Key Responsibilities

• Review and resolve clinical denials, ensuring compliance with policies and procedures
• Perform follow-ups and appeals on clinical denials, documenting actions taken
• Monitor denial accounts and report issues to management while collaborating on solutions

Required Qualifications, Training, and Education

• Licensed to practice nursing in the state of work
• 5 years of nursing experience
• Extensive knowledge of Medicare and Medicaid regulations
• Proficiency in Microsoft Office applications
• Knowledge of insurance regulations and third-party claim filing