Licensed Clinical Validation Independent Medical Reviewer Clinical Appeals Consultant

Job Summary

A company is looking for an Independent Medical Reviewer - Clinical Appeals Consultant - Clinical Validation (CV).

Key Responsibilities:

• Conduct timely and comprehensive reviews of medical records to compose convincing appeal letters based on clinical documentation
• Provide root cause analyses and performance improvement recommendations to mitigate denials
• Become proficient in utilizing proprietary software and templates

Required Qualifications:

• Graduate of accredited Nursing or Medical Discipline program with appropriate licensure
• At least three years of clinical bedside experience
• At least two years of experience as a Clinical Documentation Specialist with knowledge of clinical quality improvement principles
• Understanding of basic DRG/coding principles and CMS rules/regulations
• Subject matter knowledge and familiarity with evidence-based inpatient guidelines and criteria