Job Summary

A health insurance company is seeking a Telecommute Itemized Bill Review Resolution and Appeals Divisional Clinical Manager.

Candidates will be responsible for the following:

• Preparing summaries of the appeal information reviewed
• Leading IBR RAD in the receipt and response to facility appeal requests
• Serving as Clinical Review and Resolution Subject Matter Expert

Qualifications Include:

• 1+ years of appeal review experience
• 3+ years of experience with Medical necessity/Utilization review
• 3+ years of hospital clinical experience
• Active RN license
• Basic understanding of inpatient hospital billing methodology