RN Clinical Appeals Analyst

Job Summary

Working remotely on a full-time basis, the RN Clinical Appeals Analyst will manage clinical appeals reviews, analyze medical records, respond to claim inquiries, and support internal quality functions while adhering to business hours of 8:00am - 5:00pm.

Key responsibilities

• Analyze IBR Clinical Appeals, including medical record reviews and preparation of written appeal responses
• Respond to various levels of appeals using clinical judgment and coding knowledge
• Support training and onboarding of new hires while maintaining process documentation and quality checks

Required qualifications

• Undergraduate nursing degree
• Unrestricted RN (registered nurse) license
• 2+ years of appeals experience (coding or auditing)
• Experience with CPT-4 coding and ICD10 CM/PCS coding
• Experience supporting internal quality functions and process documentation