Tennessee Licensed Appeals Analyst

Job Summary

A company is looking for an Appeals Analyst for Medicare Part B.

Key Responsibilities

• Researches and documents complex appeal or retrospective review requests in compliance with regulations
• Performs thorough reviews of service appeals based on clinical documentation and contractual requirements
• Conducts special projects to identify quality of care issues through clinical information reviews

Required Qualifications and Education

• Associate's degree in a job-related field or graduate of an accredited school of nursing
• 2 years of clinical experience plus 1 year of utilization/medical review or quality assurance, or 3 years of clinical experience
• Active, unrestricted RN license from the United States or compact multistate RN license
• Working knowledge of managed care and healthcare delivery systems
• Strong clinical experience, including home health and rehabilitation