Job Summary
A health services company is filling a position for a Clinical Appeals Registered Nurse.
Individual must be able to fulfill the following responsibilities:
- Address Standard and Expedited appeals cases, and complete a standard number of case volume/day
- Complete the Standard appeals cases within 25-30 calendar days and Expedited appeals cases within 24-72 hours
- Research issues to mitigate risk, and work closely with Regulatory and Claims departments
Applicants must meet the following qualifications:
- BSN degree or higher; Experience in appeals; CPT, HCPC, ICD-9 and ICD-10 coding experience
- Ability to obtain RN license in State of California if selected for this role
- 3+ years of clinical experience in a hospital or other acute care setting
- Current, unrestricted RN license in the state of residency
- History of navigating a Windows based environment, encompassing exceptional typing skills
- Previous experience in a production environment either in telephonic or office-based role is preferred
