Virginia Licensed RN Clinical Appeals

Job Summary

A company is looking for an RN Clinical Appeals.

Key Responsibilities

• Contact insurance plans to determine reasons for claim denials and analyze claims to decide if appeals are necessary
• Prepare appeal materials, including correcting and resubmitting claims and gathering additional medical information
• Collaborate with various departments to communicate denial trends and outcomes effectively

Required Qualifications, Training, and Education

• Current unrestricted license to practice nursing (LPN, RN)
• CRCR or other approved professional certification required within 9 months of hire
• 1 to 3 years of relevant job experience
• Associate's Degree or equivalent experience in Nursing or a relevant discipline
• Preferred: 2 years of experience in denials, utilization review, or case management