Job Summary

A healthcare services company needs applicants for an opening for a Telecommute Clinical Appeals Nurse in Orange Park.

Core Responsibilities of this position include:

• Identifying problem accounts/processes/trends and escalate as appropriate
• Composing clinical appeal letters to send to payers for denial reconsiderations utilizing documentation, contract language, or voice recordings
• Presenting a concise medical summary within each appeal based on support from the medical record

Required Skills:

• Must be able to maintain long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
• At least one year case management experience required
• State RN or LPN License required (Active/Inactive)
• Relevant education may substitute experience requirement
• Must demonstrate knowledge and understanding of organizational policies, procedures and systems
• Must demonstrate proficiency in Microsoft Office applications and others as required