Registered Nurse Clinical Appeals

Job Summary

A company is looking for a Clinical Denials and Appeals RN.

Key Responsibilities

• Conduct pre and post service medical necessity reviews for various hospital encounters
• Prepare, submit, and track clinical appeals while collaborating with multiple teams to resolve denials
• Maintain accurate documentation of review activities and track denial and appeal outcomes

Required Qualifications

• Current unrestricted Registered Nurse license in the state of residence
• University Degree and 4-6 years of relevant acute care clinical experience
• Prior experience in clinical denials, utilization review, case management, or appeals
• Experience with InterQual and/or Milliman Care Guidelines, and electronic medical record systems
• Strong knowledge of hospital revenue cycle workflows and payer regulations