Licensed Clinical Claims Nurse

Job Summary

A company is looking for a Clinical Claims Nurse (Healthcare Provider).

Key Responsibilities:

• Analyze medical records and case files to produce objective summaries for dispute resolution
• Exercise independent judgment to make evidence-based decisions in compliance with regulations and standards
• Conduct detailed research to support accurate decision-making and stay informed of healthcare developments

Required Qualifications:

• Associate's degree or higher in a healthcare-related field from an accredited institution
• LPN or RN License
• Minimum of three years' experience in medical appeals or related healthcare roles
• Background in Nursing, Physical Therapy, Occupational Therapy, or Respiratory Therapy
• Possession of a coding certification is a plus