State Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Denials Specialist.

Key Responsibilities

• Completes clinical review of pre- and post-claim denials
• Performs a variety of audit services including charge audit and compliance audit
• Documents findings and submits them to client management for billing adjustments

Required Qualifications

• RN Certification
• CCDS or CDIS Certification preferred
• Experience with DRG Denials
• Epic experience preferred
• Experience with InterQual and Medical Necessity