Job Summary

A consulting company needs applicants for an opening for a Remote Clinical Appeals Review Nurse.

Must be able to:

• Review cases and determine the potential for a Provide Appeal, on the denied claim
• Ensure work load is completed in an efficient and timely manner
• Writes quality appeal letters to achieve maximum overturn rate

Qualifications for this position include:

• Working knowledge of billing codes, revenue codes, CPT' s, etc
• RN License
• 5+ years of acute hospital experience
• Possess knowledge and experience with national clinical criteria applied in case management
• Experience and knowledge of managed care contracts, account receivables, and revenue cycle functions
• Ability to examine financial and clinical data trends and provide recommended action steps to resolve