RN Licensed Clinical Appeals Analyst

Job Summary

A company is looking for a Clinical Appeals Analyst to manage claim denials and facilitate appeals processes.

Key Responsibilities

• Review and appeal clinical level denials related to hospital claims
• Audit medical records and prepare appeal correspondence
• Monitor and coordinate denial resolutions with payers

Required Qualifications

• 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, but equivalent experience will be considered
• Experience using standardized clinical guidelines, with InterQual experience preferred