Job Summary
A healthcare company is filling a position for a Virtual Clinical Appeals Manager.
Candidates will be responsible for the following:
- Overseeing and coordinating appeals process
- Assuring each supervisor provides one to one support and QA monitor for nurses, assisting with analysis and problem solving
- Analyzing patterns and trends of denial decisions and implementing strategic changes to respond to the payer behavior
Applicants must meet the following qualifications:
- Bachelor’s Degree in Nursing or equivalent experience
- Current, unrestricted RN License
- 5+ years in leadership within a health plan, hospital or revenue cycle company in management of a dynamic team of at least 10
- Demonstrated ability to make meaning of large data sets
- Experience working in a matrix environment with responsibility to multiple stakeholders
- Experience writing clinical appeals to a variety of payers
