RN Licensed Clinical Claims Nurse

Job Summary

A company is looking for a Clinical Claims Nurse.

Key Responsibilities

• Review medical records and write clear, concise dispute resolution decisions
• Make independent decisions based on medical evidence and regulations
• Address all appeal/dispute issues raised by patients or providers

Required Qualifications

• Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline
• RN or LLP license required
• Three years of experience in medical dispute resolution or related healthcare experience
• Experience in nursing, physical therapy, respiratory therapy, or occupational therapy preferred
• Demonstrated experience in writing appeal or payment determinations