South Dakota Licensed Appeal Specialist

Job Summary

A company is looking for a Senior Appeal and Denial Specialist.

Key Responsibilities

• Facilitate the denial and appeal process by reviewing medical records for medical necessity and policy requirements
• Administer and prioritize daily tasks while ensuring compliance with regulatory requirements and organizational policies
• Conduct reviews of clinical-based denials and coach patients on managing their care proactively

Required Qualifications, Training, and Education

• Bachelor's degree required, or equivalent experience considered
• Graduation from a nationally accredited nursing program preferred
• Three years of experience in appeals, medical necessity, or prior authorization processes
• Current nursing license with applicable State Nursing Board or multistate licensure privileges if a nursing program graduate