State Licensed Clinical Appeals Analyst

Job Summary

A company is looking for a Clinical Appeals Analyst, responsible for managing claim denials and appeals related to hospital claims.

Key Responsibilities

• Review and appeal clinical level denials, including issues of medical necessity and authorization
• Audit medical records and prepare appeal correspondence
• Monitor and coordinate denial resolution with payers while maintaining professional communication

Required Qualifications

• Current RN or LPN 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, or equivalent job experience
• Experience with standardized clinical guidelines, preferably InterQual