Job Summary

A consulting firm has a current position open for a Remote Clinical Appeals Review Nurse.

Core Responsibilities Include:

• Writing quality appeal letters to achieve maximum overturn rate
• Ensuring workload is completed in an efficient and timely manner
• Updating the applicable logs for appropriate follow up purposes including payor requested reports

Qualifications Include:

• A valid Registered Nurse (RN) License
• Five or more years of acute hospital experience
• Possess knowledge and experience with national clinical criteria applied in case management
• Working knowledge of billing codes, Revenue Codes, CPT’ s, etc
• Experience and knowledge of managed care contracts, account receivables and revenue cycle functions
• Experience and success in appealing managed care denials and underpayment decisions