Licensed Clinical Appeals Advocate

Job Summary

Serving as a key patient advocate, the full-time Licensed Clinical Appeals Advocate will work remotely to support individuals denied insurance coverage for respiratory health products by developing appeal strategies, gathering clinical documentation, and collaborating with healthcare teams and payers to secure access to necessary therapies.

Key responsibilities

• Assess cases and prepare persuasive appeal submissions for commercial and government payers
• Communicate with patients to explain appeal strategies and support them in preparation for hearings
• Build and maintain professional relationships with case managers and medical directors to promote positive patient outcomes

Required qualifications

• Registered Nurse (RN), Respiratory Therapist (RT), or Licensed Practical Nurse (LPN) with active state licensure or certification
• Associate degree or higher, or equivalent work experience in a related clinical or reimbursement field
• Minimum of 3 years of experience reviewing medical records and securing third party reimbursement preferred
• Knowledge of federal, state, and local regulations, including HIPAA requirements and payer guidelines
• Proficiency in Microsoft Office and related software tools