RN Clinical Appeals Reviewer

Job Summary

A company is looking for an IBR Clinical Appeals Reviewer - Remote.

Key Responsibilities:

• Analyze scope and resolution of IBR Appeals
• Respond to Level one, two, or higher appeals and perform complex conceptual analyses
• Collaborate with auditors and leadership to review medical records and recommend appropriate actions

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
• Advanced knowledge of regulations, compliance, and composing professional appeal responses