Wisconsin Licensed Appeal Specialist

Job Summary

A company is looking for an Appeal and Denial Specialist - Health Plan Claims.

Key Responsibilities

• Coordinate documentation and handle correspondence related to denials and appeals
• Intake and assess appeals and denials, making determinations based on policy documents and medical criteria
• Communicate determinations to members, providers, and third parties regarding the status of appeals and denials

Required Qualifications, Training, and Education

• Bachelor's degree required, or a combination of degree completion and applicable experience
• Preferred graduate from a nationally accredited nursing program
• One (1) year of experience in appeals, medical necessity, or prior authorization processes
• Current licensure with the applicable State Nursing Board if a nursing program graduate