RN Licensed Clinical Appeals Analyst

Job Summary

A company is looking for a Clinical Appeals Analyst.

Key Responsibilities

• Review and appeal clinical level denials related to managed care and insurance claims
• Audit medical records and prepare appeal correspondence
• Coordinate denial resolution efforts with payers and track denial trends

Required Qualifications, Training, and Education

• Licensed as an RN or LPN with a current state nursing license
• At least 3 years of experience as a Case Manager or equivalent
• Preferred 1 year of experience with medical necessity appeals
• Bachelor's degree desirable; equivalent job experience considered
• Experience with standardized clinical guidelines, preferably InterQual