Registered Nurse Clinical Appeals Reviewer

Job Summary

A company is looking for a Clinical Appeals Reviewer.

Key Responsibilities

• Process appeals while ensuring compliance with regulatory milestones
• Review medical records for accuracy and compliance with billing codes
• Engage with appellants, providers, and members to gather necessary information for appeals

Required Qualifications, Training, and Education

• Bachelor's degree (BSN) required
• 3 or more years of experience in a related clinical setting
• Current and unrestricted Registered Nurse (RN) licensure or compact state licensure
• Working knowledge of InterQual criteria
• Proficiency in a Windows 10 environment and MS Office applications