LPN Clinical Appeals Analyst

Job Summary

To support healthcare providers in managing claims, the full-time remote LPN Clinical Appeals Analyst will review claim denials, conduct appeals requiring clinical interpretation, and address coding or documentation issues to facilitate the overturning of denials.

Key responsibilities

• Review and appeal clinical level denials, including those related to medical necessity and authorization issues
• Audit medical records for clinical information and prepare appeal correspondence
• Collaborate with the team to monitor and coordinate denial resolutions with payers

Required qualifications

• Current state nursing license as an LPN
• Minimum of 3 years of experience as a Case Manager or equivalent
• At least 1 year of experience with medical necessity appeals preferred
• Experience using standardized clinical guidelines, with InterQual experience preferred
• Bachelor's degree desirable, but equivalent job experience will be considered